Presentation
Status post gunshots injury underwent laparotomy and left internal iliac vein ligation.
Patient Data
There are about 29 x 18.5 x 59 mm well-defined clusters of admixed gas and soft tissue at the left pelvic cavity immediately medial to the left internal iliac artery it has a geometric shape and no remarkable enhancement in the post-contrast study.
Case Discussion
In this case, an adult male patient post gunshot injury underwent laparotomy, ligation of the left internal iliac vein, and left iliac fossa colostomy, and the surgeon used homeostatic material (Surgicel).
Surgical hemostatic material is used to control bleeding intraoperatively and is hence frequently intentionally left in the operative bed, not to be confused with a gossypiboma which is caused by foreign material left behind in error. Its use has increased with the advent of minimally invasive surgery and compliments other hemostatic techniques such as cautery. In imaging studies, it can mimic an abscess, tumor, lymph node or retained foreign body.
Be cautious about labeling well-defined clusters of admixed gas and soft tissue without definable marginal enhancement as abscesses or gossypiboma. Check with the operating surgeon whether surgical hemostatic material was used.
Acknowledgement: Dr Abdulltif Magram (radiologist), Dr Ahmed Albtah (general surgeon) and Dr Muneer Alwesabi (general surgeon) contributed to the diagnosis of this patient.