Case report: An oxidized cellulose granuloma — another hepatic pseudotumour?

Bradley, Mike; Singh, Gajendra

doi:10.1016/s0009-9260(05)80876-1

Cited by 14 publications

(4 citation statements)

References 5 publications

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“…tO In the previous case report, oxidized cellulose had a very different appearance. 6 In this case, Surgicel caused an intrahepatic granuloma, which was diag- nosed incidentally 4 months after the performance of an open cholecystectomy that had been complicated by bleeding. This granuloma did not contain gas and, therefore, had few of the sonographic features we describe.…”

Section: Discussionmentioning

confidence: 87%

Sonographic appearance of oxidized cellulose (Surgicel): pitfall in the diagnosis of postoperative abscess.

Melamed

Paulson

Kliewer

1995

Journal of Ultrasound in Medicine

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Oxidized regenerated cellulose (Surgicel) is used for intraoperative hemostasis and frequently is left in the surgical bed. We describe the sonographic appearance of Surgicel, which may mimic an abscess in the postoperative setting. Sonograms from six postoperative patients with retained Surgicel were collected. The use of Surgicel was confirmed by consultation with the operating surgeon. In five patients, correlative CT scans were performed. All cases appeared as echogenic masses with posterior reverberation artifact suggestive of an abscess due to gas forming organisms. In three patients, fluid surrounded the echogenic masses. Correlative CT scans showed that the Surgicel masses contained complex collections of fluid and gas. Five of six patients showed no clinical evidence of an abscess. The presence of echogenic masses with posterior reverberation artifact in postoperative patients should alert the sonologist that Surgicel may have been used, and an appropriate history should be sought.

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Section: Discussionmentioning

confidence: 87%

Sonographic appearance of oxidized cellulose (Surgicel): pitfall in the diagnosis of postoperative abscess.

Melamed

Paulson

Kliewer

1995

Journal of Ultrasound in Medicine

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“…The primary hemostatic mechanism of oxidized cellulose is its ability to bind to hemoglobin and facilitate the formation of a thrombus. Platelet aggregation and adjacent foreign body reaction also contribute to its hemostatic properties [ 2 ] .…”

Section: Introductionmentioning

confidence: 99%

CT appearances following laparoscopic partial nephrectomy for renal cell carcinoma using a rolled cellulose bolster

et al. 2010

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Purpose: To describe the evolving computed tomography (CT) appearances of a cellulose surgical bolster used as a hemostatic agent in patients who undergo laparoscopic partial nephrectomy for renal cell carcinoma. Materials and methods: We retrospectively reviewed the follow-up CT studies of 33 patients with stage T1N0M0 renal carcinoma who underwent laparoscopic partial nephrectomy using a rolled, oxidized, regenerated cellulose sheet sutured in place as a bolster in the parenchymal defect. Thirteen patients undergoing laparoscopic partial nephrectomy without the use of a bolster were also evaluated to differentiate imaging features. Results: The bolster-related masses were significantly larger than those seen in the non-bolster patients. There was a decrease in size of the post-operative bolster-related mass with time. The bolster shape evolved with time, initially appearing oval, and becoming irregular with decreasing size. Equivocal increase in attenuation of 10–20 HU was seen in 6 patients. Increase in attenuation of greater than 20 HU was seen in 3 patients. There was no evidence of tumor recurrence in any of the patients. Invagination of fat was seen in two bolster-related masses at 18 months or greater. Conclusions: Cellulose bolster has a variable appearance on follow-up CT exams. Evolutionary features include reduction in bolster size and shape with time leading finally to non-visualization. Bolster enhancement can mimic abscesses and tumor recurrence.

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“…Platelet aggregation along with a foreign body reaction also contributes to hemostasis. [ 5 6 ] In partial nephrectomies, the defect created is closed using oxidized cellulose with gelatin matrix (Surgiflo TM Ethicon) and combination of both has been conventionally used in closing large defects. A review article has described use of bolsters as a gold standard for closing defects post partial nephrectomy, however, search of literature shows no study showing superiority of using bolsters over using no bolsters.…”

Section: Discussionmentioning

confidence: 99%

Bolster material granuloma masquerading as recurrent renal cell carcinoma following partial nephrectomy

Singh

Jai

Ganpule

et al. 2016

Indian Journal of Radiology and Imaging

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Nephron sparing surgery has seen a phenomenal rise in its application over the past few decades. The use of Surgicel and gel foam for closure of defect created after partial nephrectomy has become a routine practice at many centers. In this case report, we describe radiological artifact secondary to a surgical bolster mimicking a residual disease or an early recurrence in the kidney. This case highlights two facts; first, reapproximation of the renal tissue is best done without the use of Surgicel bolsters. Second, bolsteroma should always be kept in mind as a differential diagnosis in a case where computed tomography (CT) imaging is showing early recurrence. If the surgeon is sure about the surgical margins being negative and the CT image shows a bolsteroma, the patient should be observed and a repeat scan should be done at 3–6 months, which would show regression or disappearance of the lesion proving it to be an artifact rather than malignant lesion.

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Case report: An oxidized cellulose granuloma — another hepatic pseudotumour?

Cited by 14 publications

References 5 publications

Sonographic appearance of oxidized cellulose (Surgicel): pitfall in the diagnosis of postoperative abscess.

Sonographic appearance of oxidized cellulose (Surgicel): pitfall in the diagnosis of postoperative abscess.

CT appearances following laparoscopic partial nephrectomy for renal cell carcinoma using a rolled cellulose bolster

Bolster material granuloma masquerading as recurrent renal cell carcinoma following partial nephrectomy

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