Oxidized cellulose mimicking a recurrent colorectal cancer: report of a case and review of the literature

Abstract

Pathophysiologically, we suppose that air and gasforming microorganisms leaked chronically from the colorectal anastomosis into the adjacent presacral space. Abscess formation therein promoted fistulization of the leak through a low-resistance path, passing between the L5-S1 vertebrae into the spinal canal and meninges. Within the meninges, air migrated into the subdural and subarachnoid spaces causing pneumospine ( Fig. 1) and, via rostral migration, pneumocranium (inset, Fig. 1). We recognize a possible contribution to this entire process by the initial diverticular mass operated 2 years ago, which at laparotomy was adherent to the sacrum and pelvic side-wall rendering it a potential source of residual inflammation and fistulization. The meningeal involvement and pneumocranium would account for his headache and positive Kernig's sign. The inflammation at L5-S1 would explain his back pain.In conclusion, we describe a previously unreported pneumocranium and pneumospine as sequelae of chronic leakage of a colorectal anastomosis. In patients presenting with neurological symptoms following previous gastrointestinal surgery, one should consider the possibility of anastomotic leak and amongst its complications, pneumocranium and pneumospine. Early recognition and prompt treatment including neurosurgical input can result in a positive clinical outcome.

Oxidized cellulose (Surgicel) based reaction post thyroidectomy mimicking an abscess: A case report

“…10,11 The bulk of these cases presented with pain or on routine follow up imaging between 6 and 52 weeks. [2][3][4][5][6][7][8][9][10][11][12] The reported case is the first reported complication to Surgicel in the head and neck surgical field. We believe that this was a type four hypersensitivity reaction based on the timing of the event and the absence of any systemic symptoms.…”

“…4,5 Surgicel has been reported as mimicking pseudocancer; abscess formation and granuloma. [2][3][4][5][6][7][8][9][10][11][12] The majority can be described by cell mediated type 4 delayed hypersensitivity and peritoneal histiocytic reactions. 10,11 The bulk of these cases presented with pain or on routine follow up imaging between 6 and 52 weeks.…”

Angioneurotic oedema secondary to oral thiamine

“…Other fillers and diluents that are ingredients in Sona Thiamine and may be responsible for this allergic reaction are plant cellulose, vegetable stearic acid and vegetable magnesium stearate. Plant cellulose was reported to produce local tissue reactions following surgical interventions 15 16. Vegetable stearic acid was also reported to cause contact dermatitis 17 18…”

Oxidized cellulose: an unusual cause of post hysterectomy hemorrhage

“…Oxidized cellulose has been reported to present as pseudo cancer; abscess and granuloma formation. [2][3][4] The bulk of these cases presented with pain or on routine follow up imaging between 6 and 52 weeks.…”

“…Haemostatic material made of oxidized cellulose facilitates the production of an artificial clot. 3,4 Although the mechanism of action is not fully understood, oxidized cellulose forms a gelatinous mass when saturated with blood. It acts as a matrix for fibrin deposition, promoting platelet plug formation and aiding surgical haemostasis.…”