Bai Yu-Feng, Niu Juan-Qin, Zhang Chao, Wang Wen, Liu Jing-Zhong
Department of Radiology, The 944th Hospital of Joint Logistics Support Force of People's Liberation Army, Jiuquan, CHN.
Department of Radiology, The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou, CHN.
Cureus. 2021 Oct 7;13(10):e18588. doi: 10.7759/cureus.18588. eCollection 2021 Oct.
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.
棉籽瘤在开放性腔隙手术中的发生率相当高，其中剖宫产位居首位。然而，剖宫产术后腹部或盆腔棉籽瘤难以诊断。我们回顾性分析了3例剖宫产术后不同时间段经病理证实为棉籽瘤患者的临床和影像学资料。病例一，剖宫产术后4个月，小肠附近的棉籽瘤导致瘘管和肠梗阻。计算机断层扫描（CT）显示沿肠管的软组织密度病变呈现“节段性蜂窝征”和边缘有金属标记的“截断征”。磁敏感伪影在T1加权像（T1WI）和T2加权像（T2WI）上表现为低信号，而在扩散加权像（DWI）上表现为高信号。病例二，剖宫产术后18个月，磁共振成像（MRI）显示腹膜和肠间隙有棉籽瘤。其特征为囊实性病变，在增强MRI扫描上有“漩涡样征”和明显的环形强化。病例三，剖宫产术后5年，右中下腹部可触及肿块。MRI显示一个T1低信号的圆形肿块，T2信号混合，在T2WI、T2WI脂肪抑制（FS）和DWI上有漩涡状低信号。在剖宫产术后疑似棉籽瘤的CT和MRI检查中，“蜂窝征”和“漩涡样征”是特征性表现；纱布移位至肠道可能显示“截断征”。准确诊断基于手术史、症状和影像学特征。
