Computed Tomography and Magnetic Resonance Imaging Appearances of Abdomen and Pelvis Gossypibomas at the Varied Durations After Cesarean Section

Abstract

The incidence of gossypiboma is considerably higher in open cavity surgeries, among which cesarean section ranks number one. However, it is difficult to diagnose abdomen or pelvic gossypibomas after cesarean section. We retrospectively analyzed the clinical and imaging data of three pathologically confirmed gossypiboma patients at varied durations after cesarean section. In case one, at four months after cesarean section, a gossypiboma near the small intestine caused fistula and intestinal obstruction. Soft tissue density lesion along the intestinal canal made the "segmental honeycomb sign" and "truncation" with metal markings on the edge on computed tomography (CT). Magnetic sensitivity artifacts were demonstrated as hypointensity on T1 weighted image (T1WI) and T2 weighted image (T2WI), while hyperintensity was seen on the diffusion weighted image (DWI). In case two, a gossypiboma in the peritoneal and intestinal space was revealed with MRI at 18 months after cesarean section. It was featured as a cystic and solid lesion, with "vortex like sign" and obvious ring enhancement on contrast-enhanced MRI scan. In case three, five years after cesarean section, a mass was palpated in the right middle and lower abdomen. MRI revealed a round mass of T1 hypointensity with mixed T2 signal, as well as swirling hypointensity in T2WI, T2WI-fat suppression (FS), and DWI. In CT and MRI examinations for suspected gossypiboma after cesarean section, "honeycomb sign" and "vortex like sign" are the characteristic appearances; gauze translocated into the intestine may show the "truncation sign". Accurate diagnosis is based on the surgery history, symptoms, and imaging features.

Gossypiboma, the Hidden Enemy of an Emergency Cesarean Hysterectomy—Case Report and Review of the Literature

“…Afterward, the evaluation can be performed by using radiological investigations to diagnose an intestinal occlusive process of a modified anatomical topography and less of the formation due to the lack of radiopaque markers. Completing the imaging evaluation using CT and MRI increases the chances of preoperative diagnosis of this pathology [ 8 , 42 ] ( Table 2 ).…”

“…Afterward, the evaluation can be performed by using radiological investigations to diagnose an intestinal occlusive process of a modified anatomical topography and less of the formation due to the lack of radiopaque markers. Completing the imaging evaluation using CT and MRI increases the chances of preoperative diagnosis of this pathology [8,42] (Table 2). The most frequent possible complications described secondary to the presence of gossypiboma were represented by fistulas (19.29%) [10,13,19,20,23,27,32,33,37,50], perforations (12.28%) [1,26,29,44,45,51,53], obstructions (5.26%) [11,32,37], and bladder injuries [34] (Table 3).…”

“…Imaging diagnosis is based on endovaginal/abdominal ultrasonography, abdominal–pelvic radiological examination, contrast-enhanced computed tomography, and magnetic resonance imaging [ 8 ]. The differential diagnosis must also be performed with other intra-abdominal tumor masses [ 9 ].…”