Surgical haemostatic sponge mimicking an abscess

Case contributed by Dr Vikas Shah

Presentation

Difficult hysterectomy with intra-operative bleeding. Dropped Hb post-operatively. Re-look laparotomy to control bleeding. Now septic. CT to look for collections.

Patient Data

Age: 45 years
Gender: Female

There is a collection containing fluid with enhancing margins immediately superior to the vaginal apex. This contains a couple of bubbles of gas. Immediately superior and anterior to this collection is another one, containing more gas, admixed with soft tissue density material. This has a curved shape, concave anteriorly. 

Case Discussion

The collection containing gas admixed with soft tissue was misinterpreted as being a contained faecal leak from perforated bowel, particularly in light of the complicated surgery and current sepsis. However, it is very well defined and lies immediately adjacent to the ligated vaginal stump where there was copious bleeding at surgery. There is no enhancing margin as would be expected for an abscess. This is surgical haemostatic material (oxidised cellulose), confirmed in the operative notes. It is important to be aware of this appearance such that abscesses and collections are not "over-called".

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Case information

rID: 54790
Case created: 28th Jul 2017
Last edited: 20th Nov 2017
System: Gynaecology
Inclusion in quiz mode: Included

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