Morita Akari, Kakinuma Toshiyuki, Segawa Arimi, Harada Satoshi, Takae Seido, Tamura Midori, Suzuki Nao
Department of Obstetrics and Gynecology, Saint Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama 2410811, Kanagawa, Japan.
Department of Obstetrics and Gynecology, Saint Marianna University School of Medicine, Kawasaki 2168511, Kanagawa, Japan.
World J Clin Cases. 2025 Oct 16;13(29):110454. doi: 10.12998/wjcc.v13.i29.110454.
Oil-based iodinated contrast media have excellent contrast properties and are widely used for hysterosalpingographic evaluation of female infertility. On abdominal radiography and computed tomography (CT) scans, their radiodensity is similar to that of metallic objects, which can sometimes lead to diagnostic confusion in the postoperative settings. In this case, retained oil-based contrast medium was observed on an abdominal radiograph following a cesarean section, making it difficult to differentiate from an intraperitoneal foreign body from surgery.
The patient was a 37-year-old pregnant woman who was referred to our hospital at 32 weeks and 1 day of pregnancy due to complete placenta previa for management of pregnancy and delivery. An elective cesarean section was performed at 37 weeks and 3 days. A plain abdominal radiograph taken immediately after surgery revealed a near-round, hyperdense, mass-like shadow with a regular margin in the pelvic cavity. An intraperitoneal foreign body was suspected; therefore, an abdominal CT scan was performed. The foreign body was located on the left side of the pouch of Douglas and had a CT value of 7000 Hounsfield units, similar to that of metals. The CT value strongly suggested the presence of an artificial object. However, further inquiries with the patient and her previous physician revealed a history of hysterosalpingography. Accordingly, retained oil-based iodinated contrast medium was suspected, and observation of the object's course was adopted.
When intraperitoneal foreign bodies are suspected on postoperative radiographs, the possibility of oil-based iodinated contrast medium retention should be considered.
油基碘化造影剂具有出色的造影特性，广泛用于女性不孕症的子宫输卵管造影评估。在腹部X线摄影和计算机断层扫描（CT）中，它们的放射密度与金属物体相似，这有时会在术后导致诊断混淆。在本病例中，剖宫产术后腹部X线片上观察到残留的油基造影剂，难以与手术造成的腹腔内异物区分开来。
患者为一名37岁孕妇，因完全性前置胎盘于妊娠32周零1天转诊至我院进行妊娠和分娩管理。在妊娠37周零3天进行了择期剖宫产。术后立即拍摄的腹部平片显示盆腔内有一个近乎圆形、高密度、肿块样阴影，边缘规则。怀疑有腹腔内异物；因此，进行了腹部CT扫描。异物位于Douglas陷凹左侧，CT值为7000亨氏单位，与金属相似。该CT值强烈提示存在人工物体。然而，进一步询问患者及其之前的医生发现有子宫输卵管造影史。因此，怀疑是残留的油基碘化造影剂，并采取了观察该物体变化过程的措施。
当术后X线片怀疑有腹腔内异物时，应考虑油基碘化造影剂残留的可能性。
