Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

RADIOLOGICAL QUIZ
Year
: 1999  |  Volume : 9  |  Issue : 2  |  Page : 81--82

Radiological quiz: Abdomen


Kavita Saggar, Rekha Goyal, SC Goyal, Parambir Sandhu, Kushaljit S Sodhi 
 Department of Radiology, Dayanand Medical College and Hospital, Ludhiana, India

Correspondence Address:
Kavita Saggar
C/o Dental Care & Cure Centre, 132-B, Rani Jhansi Road, Ludhiana
India




How to cite this article:
Saggar K, Goyal R, Goyal S C, Sandhu P, Sodhi KS. Radiological quiz: Abdomen.Indian J Radiol Imaging 1999;9:81-82


How to cite this URL:
Saggar K, Goyal R, Goyal S C, Sandhu P, Sodhi KS. Radiological quiz: Abdomen. Indian J Radiol Imaging [serial online] 1999 [cited 2019 Nov 19 ];9:81-82
Available from: http://www.ijri.org/text.asp?1999/9/2/81/28340


Full Text

A thirty-years-old woman was admitted with the complaint of a discharging sinus in the infra-umbilical region for the last three months. Past medical history was unremarkable except for a history of lower segment Cesarian section three and half months ago.

A sinusogram was performed by injecting ionic contrast through the sinus opening. This was immediately followed by a CT [Figure 1],[Figure 2].

 View Answer

 DIAGNOSIS:



Retained Surgical Sponge (Textiloma)

An opacified tract was seen in the anterior abdominal wall communicating with a well encapsulated mass in the lower abdomen. The mass showed a heterogeneous pattern with mottled air within.

At laparotomy, a surgical sponge left in place from prior surgery was retrieved from the anterior part of the peritoneal cavity with foul smelling pus. The sinus tract was excised

The radiographic demonstration of foreign bodies in the abdomen, particularly post-operative foreign bodies has been well documented [1],[2]. According to Williams et al . [3], the most common surgically retained foreign body is the laparotomy sponge. The majority of surgically retained foreign bodies lead to complications related to inflammation and infection. Encapsulated abscesses, fecal fistulae, erosion and perforation into adjacent viscera have been reported [1],[2].

Sheward et al . described a case of a gossypiboma resulting in a large abscess with erosion into the lumen of the small bowel at multiple sites [5]. Kopka et al . reported the presence of gas bubbles in textilomas in seven of thirteen patients evaluated with CT. They also evaluated eight samples of surgical sponges placed in a water bath for six months and demonstrated the presence of gas bubbles in all surgical sponges scanned after one hour. The number of gas bubbles was not significantly reduced after six months indicating that the presence of gas bubbles is a specific sign for the detection of textilomas. If present, typical spongiform pattern with gas bubbles is the most specific sign for detection of textilomas [4].

References

1Olnick HM, Weens HS, Rojen JV. Radiological diagnosis of retained surgical sponges. JAMA 1955; 59: 1525-7.
2Robinson KB, Levin EJ. Erosion of retained surgical sponges into the intestine. Am J Roentgenol Radium Ther Nucl Med 1966; 96: 339-43.
3Williams RG, Bragg DG, Nelson JA. Gossypiboma - the problem of retained surgical sponge. Radiology 1978; 129: 323-6.
4Kopka L, Fischer U, Gross AJ, Funke M, Oestmann JW. Grabbe E.CT of retained surgical sponges (textilomas); pitfalls in detection and evaluation. Journal of Computer Assisted Tomography 1996; 20: 919-23.
5Scott E Sheward, Arvis G Williams, Jr, Fred A Mettler Jr and Stuart R Lacey. CT appearance of a surgically retained towel (Gossypiboma) Journal of Computer Assisted Tomography, 1986; 10: 343-5.