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

Singh, Abhishek; Jai, Shrikant; Ganpule, Sanika A; Ganpule, Arvind

doi:10.4103/0971-3026.190418

Cited by 7 publications

(8 citation statements)

References 12 publications

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“…[1,11] In addition, foreign-body reactions to unabsorbed Surgicel have been found to mimic a mass or abscess. [12,13] Vascular compression secondary to Surgiceloma is much less common, and all previously reported cases occurred following cardiovascular surgery. Formation of a hematoma around unabsorbed Surgicel has been reported to result in superior vena cava (SVC) syndrome, via compression of the SVC following mitral valve repair.…”

Section: Discussionmentioning

confidence: 99%

Extrinsic Compression of Transplant Hepatic Artery by a Hemostatic Agent: “Surgiceloma”

Tariq

Landis

Kotru

et al. 2019

The Arab Journal of Interventional Radiology

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A 38-year-old man who underwent liver transplantation was found to have absent vascular flow in the common hepatic artery (CHA) on Doppler ultrasound and angiogram 1 day after surgery. Surgical reexploration revealed a mass of expanded Surgicel compressing the CHA. Surgicel is an absorbable hemostatic agent used to control intraoperative bleeding. Blood flow was restored once the mass was removed, and the patient recovered uneventfully. Interventional radiologists need to recognize this finding of extrinsic vascular compression on hepatic angiogram to avoid unnecessary interventions. Furthermore, increased awareness of the clinical and imaging findings associated with compression of an artery by a "Surgiceloma" may increase the consideration of this phenomenon as a differential in the setting of postoperative impaired perfusion.

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Section: Discussionmentioning

confidence: 99%

Extrinsic Compression of Transplant Hepatic Artery by a Hemostatic Agent: “Surgiceloma”

Tariq

Landis

Kotru

et al. 2019

The Arab Journal of Interventional Radiology

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“…Among all 38 cases described, plus our reported case, 11 patients were treated conservatively due to suspicion of an OC-retaining lesion after surgical history evaluation and multidisciplinary analysis by surgeons and radiologists. Although retained OC has been described by many authors [ 27 – 29 , 31 , 32 , 34 – 56 ], we believe it is important to focus on the cases in which there were severe complications in order to form some conclusions and recommendations…”

Section: Discussionmentioning

confidence: 99%

Practical Suggestions for Prevention of Complications Arising from Oxidized Cellulose Retention: A Case Report and Review of the Literature

et al. 2018

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Patient: Male, 51Final Diagnosis: Oxidised cellulose retainSymptoms: Abdominal pain • nausea • vomitingMedication: —Clinical Procedure: Laparoscopic abdominal exploration and drainageSpecialty: SurgeryObjective:Challenging differential diagnosisBackground:Bleeding is a major intraoperative complication during surgical procedures. When conventional methods such as ligature and diathermocoagulation are ineffective for bleeding management, hemostatic agents should be used. Oxidized cellulose is one of the major hemostatic agents used worldwide. Oxidized cellulose is often left in situ after hemostasis because of its high level of reabsorption that lasts up to 8 weeks. However, 38 cases of retaining-associated complications are reported in the literature.Case Report:A 51-year-old male patient presented in our emergency department with acute abdominal pain, nausea, and vomiting. The patient had been admitted in our department for laparoscopic cholecystectomy for acute cholecystitis 25 months previously. Abdominal ultrasound and CT scan showed the presence of a cystic circular mass, with homogeneous fluid content, close to the surgical clips of the previous surgery, resembling a “neo-gallbladder”. Laparoscopic abdominal exploration and drainage were performed. Histological examination reported protein-based amorphous material with rare lymphocytes and macrophages. Culturing was negative for bacterial growth. The patient was discharged uneventfully on the 4th postoperative day. The primary surgical report was evaluated with evidence of application of Gelita-Cel® Standard for hemostatic purposes. Results of 12-month follow-up were normal.Conclusions:Herein, we report the first case of a complication associated with the use of Gelita-Cel® Standard. We reviewed the literature to better define the purpose and limits of oxidized cellulose use as a hemostatic agent. Despite the fundamental role of oxidized cellulose as a hemostatic agent, we provide some practical suggestions to prevent the reported severe complications and surgical overtreatments.

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“…The early finding of an area of enhancement in the operated kidney at CECT during follow-up represents a diagnostic challenge, considering the possible recurrence of the disease or a false positive (pseudoenhancement, granuloma, etc.) [25,[31][32][33][34][35][36][37].…”

Section: Introductionmentioning

confidence: 99%

Surgical margin follow-up after nephron-sparing surgery: the possible role of CEUS

et al. 2019

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Purpose To evaluate the possible role of CEUS in the management of patients who underwent nephron-sparing surgery (NSS) and presented questionable findings on the surgical margins at the CECT follow-up exam. Methods In our retro-prospective study, we included 952 patients with small renal masses (SRMs) treated with NSS between 2012 and 2015 and followed with CECT for at least 3 years at Careggi University Hospital. Twenty-two of them presented solid masses on the site of surgery with questionable enhancement at CECT and were further studied with CEUS. This examination was followed by a quantitative analysis of the enhancement pattern. Results Out of the 22 masses, 18 were considered possible granulomas, presenting slow wash-in and low enhancement peaks compared to the surrounding parenchyma and persistent delayed wash-out at CEUS. Four lesions presented a suspicious malignant enhancement pattern, with rapid wash-in, high peak and rapid wash-out. In accordance with instructions from the urologist, the first group of 18 patients was strictly monitored, revealing that the mass dimensions and enhancement pattern were stable for at least 3 years of follow-up, while the other 4 patients underwent a second intervention and their masses were confirmed as tumor recurrence at the histopathological evaluation. Conclusions CEUS can play a key role in the surgical margin follow-up after NSS when a suspicious enhancing mass is detected by CECT, giving an accurate depiction of the enhancement pattern and thus helping the clinician in the management of the patient.

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

Cited by 7 publications

References 12 publications

Extrinsic Compression of Transplant Hepatic Artery by a Hemostatic Agent: “Surgiceloma”

Extrinsic Compression of Transplant Hepatic Artery by a Hemostatic Agent: “Surgiceloma”

Practical Suggestions for Prevention of Complications Arising from Oxidized Cellulose Retention: A Case Report and Review of the Literature

Surgical margin follow-up after nephron-sparing surgery: the possible role of CEUS

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