CT and MRI Appearances of Abdomen and Pelvis Gossypibomas at Varied Time after Cesarean Resection

Yu-Feng Bai, Juan-Qin Niu, Chao Zhang, Jun-Tao Lu, Ju-Jing Liang, Jing-Zhong Liu and Wen Wang

Department of Radiology, The 944th Hospital of Joint Logistics Support Force of People’s Liberation Army, China Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, China   These authors contributed equally to this work

^*Correspondance to: Jing-Zhong Liu, Wen Wang 

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Abstract:

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 3 pathologically confirmed gossypiboma patients at varied time after cesarean resection. At four months after cesarean resection, gossypiboma near the small intestine caused fistula and intestinal obstruction. Soft tissue density along the intestinal canal, made the “segmental honeycomb sign" and "truncation", with metal markings on the edge on CT. Long T1 and short T2 signals and DWI metal artifacts were revealed on MRI. Eighteen months after cesarean resection, gossypiboma located in the peritoneal and intestinal space. MRI demonstrates cystic and solid features, with "vortex like sign" and obvious ring enhancement on contrast-enhanced scan. Five years after cesarean resection, gossypiboma was palpated in the right middle and lower abdomen. MRI revealed a round mass of long T1 signal with mixed T2 signal, as well as swirling lower signal in T2WI, T2WI-FS and DWI were observed. In CT and MRI examinations for suspected gossypiboma after cesarean resection, "honeycomb sign" and "vortex like sign" are the characteristic appearances; gauze transplanted into the intestine may show "truncation sign". DWI metal artifacts and surgical history can aid the diagnosis.

Keywords:

Gossypiboma; Abdominal; Computed tomography; Magnetic resonance imaging; Diagnosis

Cite the Article:

Bai Y-F, Niu J-Q, Zhang C, Lu J-T, Liang J-J, Liu J-Z, et al. CT and MRI Appearances of Abdomen and Pelvis Gossypibomas at Varied Time after Cesarean Resection. Ann Clin Case Rep. 2021; 6: 1971..