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Agrawal H, Gupta N, Krishengowda U, Gupta AK, Naskar D, Durga CK. Transmural Migration of Gossypiboma: a Rare Cause of Acute Abdomen. Indian J Surg 2017; 80:84-86. [PMID: 29581691 DOI: 10.1007/s12262-017-1660-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 06/02/2017] [Indexed: 02/08/2023] Open
Abstract
Gossypiboma is the retained foreign body which is generally a cotton sponge/gauze after surgery. Incidence of gossypiboma is around one in 3000 to 5000 surgeries. This low incidence is mainly attributed to a low case reporting due to an associated medicolegal aspect. We are reporting a case of a 38 years old male, who presented with signs and symptoms of peritonitis. The patient had a history of open cholecystectomy 2 years back. A working diagnosis of perforation peritonitis was made, and the patient underwent exploratory laparotomy. Intraoperatively, a surgical sponge was present inside the ileal lumen causing intestinal obstruction with dense adhesion of bowel loops proximal to the site of obstruction with multiple ileal perforations. Even though the incidence of gossypiboma is very low, it should always be kept in mind as a cause of chronic abdominal pain and abdominal discomfort in a patient with previous abdominal surgery.
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Affiliation(s)
| | - Nikhil Gupta
- Department of surgery, PGIMER Dr RML Hospital, New Delhi, India
| | | | | | - Dipankar Naskar
- Department of surgery, PGIMER Dr RML Hospital, New Delhi, India
| | - C K Durga
- Department of surgery, PGIMER Dr RML Hospital, New Delhi, India
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Ojha S, Gall T, Sodergren MH, Jiao LR. A case of gossypiboma mimicking intrahepatic cholangiocarcinoma. Ann R Coll Surg Engl 2014; 96:e14-6. [PMID: 25245716 PMCID: PMC4473471 DOI: 10.1308/003588414x13946184901489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION A gossypiboma refers to a cotton-based foreign body left inadvertently in the human body following a surgical procedure. Although a rare event, they tend to be found in the abdomen but few are known to be intrahepatic. CASE HISTORY We report the case of a 44 year-old man who presented with recurrent episodes of jaundice and cholangitis, on a background of a right hepatectomy for hydatid cyst excision 20 years previously. This case was discussed at our hepatobiliary multidisciplinary team meetings on several occasions and a presumed diagnosis of intrahepatic cholangiocarcinoma was made. Biopsies of the mass had purely shown inflammation and remained inconclusive. It was decided that the patient should undergo a complete extended right hepatectomy with resection and reconstruction of the left branch of the portal vein. On attempting to obtain intraoperative frozen section specimens prior to resection, open excision revealed two large swabs encased in a calcified cavity. Removal of the swabs resulted in resolution of the mass and obstructive symptoms. CONCLUSIONS Gossypiboma should be a rare differential diagnosis in all patients following a laparotomy presenting with obstructive symptoms, particularly in countries where strict surgical protocols may not be in place. This case also highlights the need to perform an intraoperative biopsy in any uncertain case of a liver lesion as we have shown that an extensive operation with its increased morbidity can occasionally be avoided.
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Affiliation(s)
- S Ojha
- Imperial College Healthcare NHS Trust, UK
| | - T Gall
- Imperial College Healthcare NHS Trust, UK
| | | | - LR Jiao
- Imperial College Healthcare NHS Trust, UK
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Ozer F, Oz I, Ozer C. Forgotten foreign object in the neck: a neck surgery complication. J Craniofac Surg 2014; 25:721-3. [PMID: 24621745 DOI: 10.1097/scs.0000000000000536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Fulya Ozer
- Department of Otorhinolaryngology Head and Neck SurgeryBaskent University Faculty of MedicineAnkara,
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Sozutek A, Yormaz S, Kupeli H, Saban B. Transgastric migration of gossypiboma remedied with endoscopic removal: a case report. BMC Res Notes 2013; 6:413. [PMID: 24124727 PMCID: PMC3816154 DOI: 10.1186/1756-0500-6-413] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 10/07/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Retained surgical instrument or sponge following an intra-abdominal surgery is a potentially dangerous medico-legal problem. The condition may manifest either as asymptomatic or severe gastrointestinal complications. Transmural migration of gossypiboma is a rare entity that may lead to bowel or visceral perforation, obstruction and/or fistula formation. Transmural migration of an intra-abdominal gossypiboma has been reported to occur in stomach, ileum, colon, bladder, vagina and diaphragm. To our knowledge, this is the fifth case reported in the medical literature. However, we report the first case of the largest gossypiboma to date: a surgical gas compress measuring 20 × 20 cm which was successfully treated endoscopically. CASE PRESENTATION A 52-year-old woman with obstructive jaundice was referred to our clinic. She had a medical history of cholecystectomy and T-tube drainage for choledocholithiasis a year previously. Abdominal ultrasonography and computed tomography revealed a mass located into the stomach which was compatible with gastric carcinoma. On the gastroscopy, a surgical gas compress that had totally migrated into the stomach was observed. The compress was successfully removed by gastroscopy through the esophagus. The recovery of the patient was uneventful. CONCLUSION Transmural migration of gossypiboma into the stomach should be considered in the differential diagnosis of any postoperative patient with obstructive jaundice symptoms. Endoscopy may be feasible for both diagnosis and treatment even though the size of gossypiboma is large. However, surgery should be considered in case of fixed reaction or incomplete migration of gossypiboma located into the stomach.
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Affiliation(s)
- Alper Sozutek
- Department of Gastroenterological Surgery, Necip Fazil State Hospital, Kahramanmaras, Turkey
- Department of Gastroenterological Surgery, Kahramanmaras Necip Fazil State Hospital, Kahramanmaras, Turkey
| | - Serdar Yormaz
- Department of Gastroenterological Surgery, Necip Fazil State Hospital, Kahramanmaras, Turkey
- Department of Gastroenterological Surgery, Kahramanmaras Necip Fazil State Hospital, Kahramanmaras, Turkey
| | - Hakan Kupeli
- Department of Gastroenterological Surgery, Necip Fazil State Hospital, Kahramanmaras, Turkey
- Department of Gastroenterological Surgery, Kahramanmaras Necip Fazil State Hospital, Kahramanmaras, Turkey
| | - Burhan Saban
- Department of Gastroenterological Surgery, Necip Fazil State Hospital, Kahramanmaras, Turkey
- Department of Gastroenterological Surgery, Kahramanmaras Necip Fazil State Hospital, Kahramanmaras, Turkey
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Lopez KT, Kuwada SK, Wong LL. Consequences of needle tract seeding of hepatocellular cancer after liver transplant. Clin Transplant 2013; 27:E400-6. [PMID: 23837571 DOI: 10.1111/ctr.12160] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2013] [Indexed: 12/12/2022]
Abstract
Although liver biopsy is a relatively safe procedure, needle tract seeding (NTS) of hepatocellular carcinoma (HCC) is described in up to 5% of patients after liver biopsy. The rate of NTS in patients with HCC who had liver transplantation is unknown. We performed a retrospective analysis of 759 HCC cases from August 1992 to August 2011. Demographics, ethnicities, risk factors, tumor characteristics, treatments, recurrence, and survival were collected. Patients who underwent percutaneous liver biopsy, resection, and transplant were identified. In all, 359 underwent biopsy to diagnose HCC and 42 patients underwent liver transplant. None of 171 patients who underwent radiofrequency ablation alone had seeding. None of the 11 patients who had biopsy and radiofrequency ablation performed in a single session developed NTS; however, two of 12 patients who had biopsy and radiofrequency ablation performed at separate sessions had NTS. Two patients underwent liver transplantation and subsequently developed needle tract seeding eventually died from HCC. Although the incidence of needle tract seeding was low in liver transplant patients, it can potentially change a curative therapy into a non-curative one. Single-session liver biopsy and radiofrequency ablation may reduce the risk of needle tract seeding of HCC.
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Affiliation(s)
- Kristi T Lopez
- Department of Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA
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Kato T, Yamaguchi K, Kinoshita K, Sasaki K, Kagaya H, Meguro T, Morita T, Takahashi T, Tamaki N, Horita S. Intestinal Obstruction due to Complete Transmural Migration of a Retained Surgical Sponge into the Intestine. Case Rep Gastroenterol 2012; 6:754-9. [PMID: 23341797 PMCID: PMC3551410 DOI: 10.1159/000346285] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A 56-year-old woman with a history of gynecological surgery for cervical cancer 18 years previously was referred to our hospital for colicky abdominal pain, nausea and vomiting. Intestinal obstruction was diagnosed by contrast-enhanced computed tomography (CT) which showed dilation of the small intestine and suggested obstruction in the terminal ileum. In addition, CT showed a thick-walled cavitary lesion communicating with the proximal jejunum. 18F-fluorodeoxyglucose positron emission tomography showed abnormal uptake at the same location as the cavitary lesion revealed by CT. The patient underwent laparotomy for the ileus and resection of the cavitary lesion. At laparotomy, we found a retained surgical sponge in the ileum 60 cm from the ileocecal valve. The cavitary tumor had two fistulae communicating with the proximal jejunum. The tumor was resected en bloc together with the transverse colon, part of the jejunum and the duodenum. Microscopic examination revealed fibrous encapsulation and foreign body giant cell reaction. Since a retained surgical sponge without radiopaque markers is extremely difficult to diagnose, retained surgical sponge should be considered in the differential diagnosis of intestinal obstruction in patients who have undergone previous abdominal surgery.
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Affiliation(s)
- Takashi Kato
- Department of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan
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Wang CP, Wang H, Qu JH, Lu YY, Bai WL, Dong Z, Gao XD, Rong GH, Zeng Z, Yang YP. Tumour seeding after percutaneous cryoablation for hepatocellular carcinoma. World J Gastroenterol 2012; 18:6587-96. [PMID: 23236233 PMCID: PMC3516217 DOI: 10.3748/wjg.v18.i45.6587] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 07/30/2012] [Accepted: 08/14/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the rate and risk factors for tumour seeding in a large cohort of patients.
METHODS: Over an 8-year period, 1436 hepatocellular carcinoma (HCC) patients with 2423 tumour nodules underwent 3015 image-guided percutaneous cryoablation sessions [1215 guided by ultrasonography and 221 by spiral computed tomography (CT)]. Follow-up CT or magnetic resonance imaging was performed every 3 mo. The detailed clinical data were recorded to analyse the risk factors for seeding.
RESULTS: The median follow-up time was 18 (range 1-90) mo. Seeding was detected in 11 patients (0.76%) at 1-24 (median 6.0) mo after cryoablation. Seeding occurred along the needle tract in 10 patients and at a distant location in 1 patient. Seeded tumours usually showed similar imaging and histopathological features to the primary HCCs. Univariate analyses identified subcapsular tumour location and direct subcapsular needle insertion as risk factors for seeding. Multivariate analysis showed that only direct subcapsular needle insertion was an independent risk factor for seeding (P = 0.017; odds ratio 2.57; 95%CI: 1.47-3.65). Seeding after cryoablation occurred earlier in patients with poorly differentiated HCC than those with well or moderately differentiated HCC [1.33 ± 0.577 mo vs 11.12 ± 6.896 mo; P = 0.042; 95%CI: (-19.115)-(-0.468)].
CONCLUSION: The risk of seeding after cryoablation for HCC is small. Direct puncture of subcapsular tumours should be avoided to minimise seeding.
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Kim YS. Percutaneous interventional procedures in an era of liver transplantation. THE KOREAN JOURNAL OF HEPATOLOGY 2011; 17:96-8. [PMID: 21757979 PMCID: PMC3304643 DOI: 10.3350/kjhep.2011.17.2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Squire T, Sherlock M, Wilson P, Tan B, Hope N, Anderson SE. Surfinoma: a case report on a pseudotumor developing after a surfing sports injury. Skeletal Radiol 2010; 39:1239-43. [PMID: 20711778 DOI: 10.1007/s00256-010-1020-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 07/07/2010] [Accepted: 07/28/2010] [Indexed: 02/02/2023]
Abstract
We describe an unusual pseudotumor of the upper thorax, axillary, and shoulder girdle region with presentation 4 years after a surfing sports injury. We offer the coined term "Surfinoma" to describe a pseudotumor arising from a penetrating piece of fiberglass surf board, which induced a foreign body reaction.
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Affiliation(s)
- Tim Squire
- Medical Imaging, University of Notre Dame Australia, Sydney Medical School, Darlinghurst, Sydney, Australia.
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Sakorafas GH, Sampanis D, Lappas C, Papantoni E, Christodoulou S, Mastoraki A, Safioleas M. Retained surgical sponges: what the practicing clinician should know. Langenbecks Arch Surg 2010; 395:1001-7. [PMID: 20652587 DOI: 10.1007/s00423-010-0684-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 07/01/2010] [Indexed: 01/02/2023]
Abstract
Retained surgical sponges (RSS) are an avoidable complication following surgical operations. RSS can elicit either an early exudative-type reaction or a late aseptic fibrous tissue reaction. They may remain asymptomatic for long time; when present, symptomatology varies substantially and includes septic complications (abscess formation, peritonitis) or fibrous reaction resulting in adhesion formation or fistulation into adjacent hollow organs or externally. Plain radiograph may be useful for the diagnosis; however, computed tomography is the method of choice to establish correct diagnosis preoperatively. Removal of RSS is always indicated to prevent further complications. This is usually accomplished by open surgery; rarely, endoscopic or laparoscopic removal may be successful. Prevention is of key importance to avoid not only morbidity and even mortality but also medicolegal consequences. Preventive measures include careful counting, use of sponges marked with a radiopaque marker, avoidance of use of small sponges during abdominal procedures, careful examination of the abdomen by the operating surgeon before closure, radiograph in the operating theater (either routinely or selectively), and recently, usage of barcode and radiofrequency identification technology.
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Affiliation(s)
- George H Sakorafas
- 4th Department of Surgery, Athens University, Medical School, ATTIKON U. Hospital, Arkadias 19-21, 115 26, Athens, Greece.
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Left behind: unintentionally retained surgically placed foreign bodies and how to reduce their incidence--pictorial review. AJR Am J Roentgenol 2010; 193:S79-89. [PMID: 19933680 DOI: 10.2214/ajr.09.7153] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Unintentionally retained surgically placed foreign bodies have been associated with increased morbidity and mortality, as well as increased costs and medicolegal consequences. This article reviews some of the most commonly retained surgical devices and provides a structured approach to intraoperative image acquisition and interpretation. By increasing the awareness of surgically placed foreign bodies, our goal is to reduce the incidence of and the complications associated with this difficult clinical problem. CONCLUSION Despite various systems and safeguards available, unintentionally retained surgically placed foreign bodies remain difficult to eliminate completely. Developing a standardized approach to the request, "intraoperative film, rule out foreign body," is essential to reduce the adverse outcomes associated with this problem.
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Left Behind: Unintentionally Retained Surgically Placed Foreign Bodies and How to Reduce Their Incidence—Self-Assessment Module. AJR Am J Roentgenol 2009; 193:S90-3. [DOI: 10.2214/ajr.09.7187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Chang S, Kim SH, Lim HK, Kim SH, Lee WJ, Choi D, Kim YS, Rhim H. Needle tract implantation after percutaneous interventional procedures in hepatocellular carcinomas: lessons learned from a 10-year experience. Korean J Radiol 2008; 9:268-74. [PMID: 18525230 PMCID: PMC2627263 DOI: 10.3348/kjr.2008.9.3.268] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Percutaneous interventional procedures under image guidance, such as biopsy, ethanol injection therapy, and radiofrequency ablation play important roles in the management of hepatocellular carcinomas. Although uncommon, the procedures may result in tumor implantation along the needle tract, which is a major delayed complication. Implanted tumors usually appear as one or a few, round or oval-shaped, enhancing nodules along the needle tract on CT, from the intraperitoneum through the intercostal or abdominal muscles to the subcutaneous or cutaneous tissues. Radiologists should understand the mechanisms and risk factors of needle tract implantation, minimize this complication, and also pay attention to the presence of implanted tumors along the needle tract during follow-up.
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Affiliation(s)
- Samuel Chang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Erdil A, Kilciler G, Ates Y, Tuzun A, Gulsen M, Karaeren N, Dagalp K. Transgastric migration of retained intraabdominal surgical sponge: gossypiboma in the bulbus. Intern Med 2008; 47:613-5. [PMID: 18379146 DOI: 10.2169/internalmedicine.47.0391] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 55-year-old hemiplegic woman with percutaneous endoscopic gastrostomy (PEG) was referred to our clinic for upper gastrointestinal system bleeding and for a high level of cholestatic enzymes. She had a medical history of cerebra vascular accident three years previously and cholecystectomy one year previously. We performed gastroscopy and saw a retained surgical sponge in the bulbus. After removal of the gossypiboma, endoscopic sclerotherapy was performed for the bleeding area at the bulbus. After the procedure, the upper gastrointestinal bleeding stopped and the high level of cholestatic enzymes returned to normal.
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Affiliation(s)
- Ahmet Erdil
- Department of Gastroenterology, Gulhane Military Medical Academy, Ankara, Turkey
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Stigliano R, Marelli L, Yu D, Davies N, Patch D, Burroughs AK. Seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma. What is the risk and the outcome? Seeding risk for percutaneous approach of HCC. Cancer Treat Rev 2007; 33:437-47. [PMID: 17512669 DOI: 10.1016/j.ctrv.2007.04.001] [Citation(s) in RCA: 211] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Revised: 03/30/2007] [Accepted: 04/03/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Tumour biopsy is usually considered mandatory for patient management by oncologists. Currently percutaneous ablation is used therapeutically for cirrhotic patients with small hepatocellular carcinoma (HCC), not suitable for resection or waiting for liver transplantation. However malignant seeding is a recognized complication of both diagnostic and therapeutic procedures in patients with HCC. Although percutaneous therapy whether with or without biopsy of a suspected HCC nodule may minimize the risk of seeding, this has not been confirmed. AIM To evaluate the risk of seeding, defined as new neoplastic disease occurring outside the liver capsule, either in the subcutaneous tissue or peritoneal cavity following needle biopsy and/or local ablation therapy (LAT). METHODS A literature search resulted in 179 events in 99 articles between January 1983 and February 2007: 66 seedings followed liver biopsy, 26 percutaneous ethanol injection (PEI), 1 microwave, 22 radiofrequency ablation (RFA), and 64 after combined biopsy and percutaneous treatment (5 microwave; 33 PEI; 26 RFA). RESULTS In 41 papers specifying the total number of patients biopsied and/or treated, the median risk of seeding was 2.29% (range 0-11%) for biopsy group; 1.4% (1.15-1.85%) for PEI when used with biopsy and 0.61% (0-5.56%) for RFA without biopsy, 0.95% (0-12.5%) for RFA with biopsy and 0.72% (0-10%) for liver nodules (including non-HCC nodules) biopsied and ablated. CONCLUSION Risk of seeding with HCC is substantial and appears greater with using diagnostic biopsy alone compared to therapeutic percutaneous procedures. This risk is particularly relevant for patients being considered for liver transplantation.
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Affiliation(s)
- R Stigliano
- Liver Transplantation and Hepatobiliary Medicine Unit, Royal Free Hospital, Pond Street, NW3 2QG London, UK.
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Young C, Munk PL. Hepatocellular carcinoma presenting as musculoskeletal metastases: A report of two cases. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.ejrex.2007.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tung WC, Huang YJ, Leung SW, Kuo FY, Tung HD, Wang JH, Hung CH, Lee CM, Changchien CS, Yeh SA, Sun LM, Huang EY, Hsu HC, Wang CJ, Lu SN. Incidence of needle tract seeding and responses of soft tissue metastasis by hepatocellular carcinoma postradiotherapy. Liver Int 2007; 27:192-200. [PMID: 17311613 DOI: 10.1111/j.1478-3231.2006.01399.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To determine the incidence of needle tract seeding after fine needle aspiration (FNA) or percutaneous ethanol injection (PEI) and compare iatrogenic or spontaneous soft tissue metastasis (STM) by hepatocellular carcinoma (HCC) postradiotherapy (RT) in responses. METHODS From November 1997 to January 2006, those who presented with STM by HCC after our invasive procedures or developed spontaneously were enrolled into this retrospective study. Metastatic lesions could be divided into procedure related (PR), which were located at the liver span and were related to invasive procedures, and non-procedure related (NPR), which were in extrahepatic areas. STM was treated with an electron or photon beam. RESULTS A total of 39 HCC cases with developed STM were referred for RT, including 17 in the PR group and 22 in the NPR group. During the same period, a total of 18,227 person-times of FNA or PEI were performed on these HCC patients. The overall incidence of HCC with STM that was caused by invasive procedures was estimated at 0.13%. According to the Cox' regression model, the initial treatment modality influences the time duration after the initial diagnosis of HCC when STM has not occurred. None of these patients' soft tissue tumor increased in size during RT. The PR group had lower rates of bone metastasis (P=0.003) and coexisting extrahepatic metastasis (P=0.011) and a longer survival rate (P=0.003) than the NPR group. The estimated rates of 18-gauge and 22-gauge needle-induced HCC-related STM were 0.60% and 0.11%, respectively (P=0.064). CONCLUSION The PR group bears a better prognosis than the NPR group post-RT.
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Affiliation(s)
- Wei-Chih Tung
- Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, The Division of Hepato-Gastroenterology, Chang Gung University College of Medicine, Niaosung Hsiung, Taiwan
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Choi JW, Lee CH, Kim KA, Park CM, Kim JY. Transmural migration of surgical sponge evacuated by defecation: mimicking an intraperitoneal gossypiboma. Korean J Radiol 2006; 7:212-4. [PMID: 16969052 PMCID: PMC2667604 DOI: 10.3348/kjr.2006.7.3.212] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The spontaneous defecation of the surgical retained sponge is very rare. Here, we report a case of migrating surgical sponge that was retained in the colon and it was evacuated by defecation.
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Affiliation(s)
- Jae Woong Choi
- Department of Diagnostic Radiology, Guro Hospital of Korea University, Seoul 152-703, Korea
| | - Chang Hee Lee
- Department of Diagnostic Radiology, Guro Hospital of Korea University, Seoul 152-703, Korea
| | - Kyeong Ah Kim
- Department of Diagnostic Radiology, Guro Hospital of Korea University, Seoul 152-703, Korea
| | - Cheol Min Park
- Department of Diagnostic Radiology, Guro Hospital of Korea University, Seoul 152-703, Korea
| | - Jin Yong Kim
- Department of Internal Medicine, Guro Hospital of Korea University, Seoul 152-703, Korea
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Maturen KE, Nghiem HV, Marrero JA, Hussain HK, Higgins EG, Fox GA, Francis IR. Lack of tumor seeding of hepatocellular carcinoma after percutaneous needle biopsy using coaxial cutting needle technique. AJR Am J Roentgenol 2006; 187:1184-7. [PMID: 17056903 DOI: 10.2214/ajr.05.1347] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of our study was to determine the incidence of tumor seeding after biopsy of hepatocellular carcinoma (HCC) using a coaxial cutting needle technique. Seeding along the needle track is a dreaded complication of percutaneous biopsy in patients with HCC, particularly in potential liver transplant recipients. Reported seeding rates range from 0.6% to 5.1% using various biopsy techniques. To our knowledge, the rate of seeding using a coaxial cutting needle technique has not been reported. MATERIALS AND METHODS Retrospective review identified 128 patients with imaging-guided percutaneous liver biopsies positive for HCC. A coaxial cutting needle technique was uniformly used with a 17-gauge introducer and 18-gauge biopsy needle. Radiology and clinical reports were reviewed, and findings at clinical and imaging follow-up were assessed. RESULTS During the 6-year study period, 1,012 liver mass biopsies were performed, with 128 positive for HCC (100 men and 28 women; average age, 58.4 years). One hundred one patients had more than 30 days of clinical or imaging follow-up (or both) after biopsy (mean, 410 days; range, 33-1,989 days) and constituted the study population. The remaining 27 were excluded because of inadequate follow-up. No suspected or confirmed tumor seeding on imaging, physical examination, or laparotomy was identified. CONCLUSION We found no tumor seeding after percutaneous biopsy of HCC using a coaxial cutting needle technique. This rate, 0%, is lower than those reported with other techniques. The use of a needle introducer that remains in position during multiple cutting needle passes protects normal tissue along the track and may reduce seeding. This has particular importance for patients with stage I-II HCC, for whom liver transplantation may be curative.
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Affiliation(s)
- Katherine E Maturen
- Department of Radiology, University of Michigan Hospitals, Ann Arbor, MI 48019-0030, USA.
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Tarantino L, Francica G, Esposito F, Pisaniello D, Parmeggiani D, Marzullo G, Sordelli IMF, Sperlongano P. Seeding from hepatocellular carcinoma after percutaneous ablation: color Doppler ultrasound findings. ACTA ACUST UNITED AC 2005; 31:69-77. [PMID: 16333710 DOI: 10.1007/s00261-004-0064-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2004] [Accepted: 03/16/2005] [Indexed: 12/13/2022]
Abstract
BACKGROUND We describe the clinical and color Doppler ultrasound findings in a series of cases of seeding from hepatocellular carcinoma (HCC) observed in patients treated with percutaneous ablation therapy (PAT) over a 15-year period. METHODS We reviewed the clinical and imaging records of 12 patients with cirrhosis (nine men and three women, age range 51-82 years, mean age 63 years) that showed neoplastic seeding from HCC occurring after one or more PAT procedures. Five of 12 cases of seeding were observed as a complication of 1080 PAT procedures (0.46%) performed in 545 patients (0.96%) by two of the authors (L.T., G.F.) over a long period (15 years) at different institutions. The other seven patients had been treated with PAT procedures at other institutions and had come to our attention during post-treatment follow-up. RESULTS The 12 patients who had seeding nodules had undergone the following PAT procedures: multisession conventional percutaneous ethanol injection (PEI) without anesthesia (four patients), single-session PEI with general anesthesia (three patients), single-session PEI with general anesthesia plus multisession conventional PEI (four patients), and single-session PEI plus radiofrequency ablation (one patient). Seeding nodules ranged from 0.9 to 6.0 cm (mean 1.7 cm). Eleven of 12 seeding nodules appeared as hypervascular hypoechoic nodules with smooth and regular margins and multiple intralesional vascular signals. CONCLUSIONS Clinical and imaging findings of seeding from HCC should be recognized by physicians who perform follow-up ultrasound examinations of patients who are treated with PAT. Early diagnosis of seeding can be reliably made by scanning the abdominal wall with small probes in the area where the previous PAT has been performed. Hypoechoic hypervascular pattern of the seeding nodule allows definitive diagnosis.
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Affiliation(s)
- L Tarantino
- Interventional Ultrasound Unit, Department Of Medicine, S. Giovanni Di Dio Hospital Aslna 3, Via Mario Vergara Padre, 187, 80027 Frattamaggiore, Naples, Italy.
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Sutcliffe R, Maguire D, Portmann B, Rela M, Heaton N. Selection of patients with hepatocellular carcinoma for liver transplantation. Br J Surg 2005; 93:11-8. [PMID: 16329080 DOI: 10.1002/bjs.5198] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Background
Orthotopic liver transplantation (OLT) plays a pivotal role in the management of selected patients with initial hepatocellular carcinoma (HCC). After disappointing early results and a shortage of cadaveric grafts, patients are currently selected for OLT on the basis of tumour size and number. Limitations of these criteria and the advent of living donation have prompted their re-evaluation. The principal aims of this review were to define the limitations of current transplant criteria for HCC, and to identify potential areas for improvement.
Methods
A Medline search using the terms ‘liver transplantation’ and ‘hepatocellular carcinoma’ was conducted. Additional references were sourced from key articles.
Results and conclusion
In patients with HCC, biological properties of the tumour are more accurate than radiological criteria in determining outcome after transplantation. Despite the risks of tumour biopsy, which may have been previously overstated, histological evaluation before transplantation may have a role and warrants further study. By expanding the donor pool and eliminating waiting times, live donor liver transplantation is a valuable resource that has yet to fulfil its potential because of unresolved ethical issues concerning the safety of the donor. The availability of long-term outcome data may help to clarify this in the near future.
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Affiliation(s)
- R Sutcliffe
- Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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Espinoza S, Briggs P, Duret JS, Lapeyre M, de Baère T. Radiofrequency Ablation of Needle Tract Seeding in Hepatocellular Carcinoma. J Vasc Interv Radiol 2005; 16:743-6. [PMID: 15872331 DOI: 10.1097/01.rvi.0000153109.56827.70] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A tumor needle tract seeding, 20 mm in diameter, was detected with magnetic resonance (MR) imaging in a 72-year-old man, 10 months after radiofrequency ablation of a 55-mm subcapsular hepatocellular carcinoma. This seeding was successfully treated with ultrasound-guided percutaneous radiofrequency ablation. No recurrence was found after a 2-year follow-up either on contrast-enhanced computed tomography or MR imaging. Needle tract seeding treatment is not well established. Percutaneous radiofrequency ablation of such seeding is one elegant potential treatment option. Efficacy seems promising but has to be confirmed in larger series. Further evaluation is needed.
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Affiliation(s)
- Sophie Espinoza
- Institut Gustave Roussy, Department of Interventional Radiology, Service du Pr Roche, Villejuif, France.
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Gencosmanoglu R, Inceoglu R. An unusual cause of small bowel obstruction: gossypiboma--case report. BMC Surg 2003; 3:6. [PMID: 12962549 PMCID: PMC201033 DOI: 10.1186/1471-2482-3-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2003] [Accepted: 09/08/2003] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The term "gossypiboma" denotes a mass of cotton that is retained in the body following surgery. Gossypiboma is a medico-legal problem especially for surgeons. To the best of our knowledge, the patient presented herein is the second reported patient in whom the exact site of migration of a retained surgical textile material into the intestinal lumen could be demonstrated by preoperative imaging studies. CASE PRESENTATION A 74-year-old woman presented with symptoms of small bowel obstruction due to incomplete intraluminal migration of a laparotomy towel 3 years after open cholecystectomy and umbilical hernia repair. Plain abdominal radiography did not show any sign of a radio-opaque marker in the abdomen. However, contrast enhanced abdominal computerized tomography revealed a round, well-defined soft-tissue mass with a dense, enhanced wall, containing an internal high-density area with air-bubbles in the mid-abdomen. A fistula between the abscess cavity containing the suspicious mass and gastrointestinal tract was identified by upper gastrointestinal series. The presence of a foreign body was considered. It was surgically removed with a partial small bowel resection followed by anastomosis. CONCLUSIONS Although gossypiboma is rarely seen in daily clinical practice, it should be considered in the differential diagnosis of acute mechanical intestinal obstruction in patients who underwent laparotomy previously. The best approach in the prevention of this condition can be achieved by meticulous count of surgical materials in addition to thorough exploration of surgical site at the conclusion of operations and also by routine use of surgical textile materials impregnated with a radio-opaque marker.
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Affiliation(s)
- Rasim Gencosmanoglu
- Department of Gastrointestinal Surgery, Marmara University Institute of Gastroenterology, Istanbul, Turkey
| | - Resit Inceoglu
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
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