Piozzi Guglielmo Niccolò, Reitano Elisa, Panizzo Valerio, Rubino Barbara, Bona Davide, Tringali Domenico, Micheletto Giancarlo
Department of General Surgery, University of Milan, Milano, Italy.
Department of General Surgery, Istituto Clinico Sant'Ambrogio, Milano, Italy.
Am J Case Rep. 2018 Jul 11;19:812-819. doi: 10.12659/AJCR.910060.
BACKGROUND 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 "neogallbladder". 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 4 th 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.
背景 出血是外科手术过程中的主要术中并发症。当诸如结扎和电凝等传统方法对出血管理无效时，应使用止血剂。氧化纤维素是全球使用的主要止血剂之一。由于其高吸收水平可持续长达8周，氧化纤维素在止血后常留在原位。然而，文献报道了38例与留置相关的并发症。病例报告 一名51岁男性患者因急性腹痛、恶心和呕吐就诊于我院急诊科。该患者25个月前因急性胆囊炎在我院接受腹腔镜胆囊切除术。腹部超声和CT扫描显示在先前手术的手术夹附近存在一个囊性圆形肿块，内含均匀液体，类似“新胆囊”。进行了腹腔镜腹部探查和引流。组织学检查报告为基于蛋白质的无定形物质，伴有罕见的淋巴细胞和巨噬细胞。培养结果显示细菌生长阴性。患者术后第4天顺利出院。对初次手术报告进行评估，有使用Gelita-Cel® Standard进行止血的证据。12个月随访结果正常。结论 在此，我们报告了首例与使用Gelita-Cel® Standard相关的并发症。我们回顾了文献，以更好地界定氧化纤维素作为止血剂使用的目的和局限性。尽管氧化纤维素作为止血剂具有重要作用，但我们提供了一些实用建议，以预防所报道的严重并发症和手术过度治疗。
