Retained Pelvic Oxidized Regenerated Cellulose Mistaken for Dilated Fallopian Tubes

Surgicel is oxidized regenerated cellulose used successfully for haemostasis and prevention of adhesions for many years in different surgical disciplines. However, many reports of different related complications appeared in the literature. In this manuscript I am reporting on two patients who had surgicel gauze removed from the pelvis many months after surgery because of intolerable dull pelvic pain and intermittent low-grade fever. Transvaginal ultrasound scan examinations in both cases showed tubular masses with medium echogenicity in the pelvis which were mistaken for dilated fallopian tubes. Both patients responded well after laparoscopic surgicel removal and pelvic lavage with 2 litres of warm normal saline. This was followed by instillation of 500 mg of hydrocortisone diluted in 50 ml of saline. Culture of the peritoneal contents was negative. In both cases the symptoms were mostly related to foreign body reaction as the gauze was isolated and encapsulated within a thin membrane. Furthermore, neither patient needed any antibiotics after it was removed. These are the first two case reports for retained surgicel used during laparoscopic gynaecological surgery to be mistaken for dilated fallopian tubes. I suggest that all patients who had surgicel used during similar operations should have transvaginal ultrasound scan examination one month after the procedure, or even sooner if they remained symptomatic. Any tubular pelvic mass should be explored by diagnostic laparoscopy as it might be a retained surgicel gauze. Better still, a clinical preoperative test needs to be developed to check which patients might be at risk of developing such complications.