Imaging of Retained Surgical Sponges in the Abdomen and Pelvis
Angus R. O'Connor1,
Fergus V. Coakley2,
Maxwell V. Meng3 and
Stephen Eberhardt4
1 Department of Radiology, Nottingham City Hospital, Hucknall Rd., NG5 1PB,
Nottingham, United Kingdom.
2 Department of Radiology, University of California San Francisco, Box 0628,
M-372, 505 Parnassus Ave., San Francisco, CA 94143-0628.
3 Department of Urology, University of California San Francisco, San Francisco,
CA 94143-0628.
4 Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York
Ave., New York, NY 10021.
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Fig. 1A. —Photographic and radiographic appearances of typical
laparotomy sponge. Photograph of laparotomy sponge shows that attached strip
of material (arrow) is radiopaque.
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Fig. 1B. —Photographic and radiographic appearances of typical
laparotomy sponge. Radiograph of laparotomy sponge shown in A reveals
that body of sponge is only faintly radiopaque, but marker (arrow) is
easily seen.
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Fig. 2. —Abdominal radiograph obtained 5 days after surgical formation
of antegrade continence enema (ACE Malone
[10]) mechanism because of
prolonged ileus in 10-year-old boy with spina bifida. Radiopaque marker
(arrow) of laparotomy sponge is visible in right lower quadrant.
Sponge was successfully removed by laparoscopy.
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Fig. 3A. —Photographic and radiographic appearances of 4 x 4 inch
(10 x 10 cm) surgical sponge. Photograph of surgical sponge shows that
interwoven radioopaque marker (arrow) is visible.
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Fig. 3B. —Photographic and radiographic appearances of 4 x 4 inch
(10 x 10 cm) surgical sponge. Radiograph of surgical sponge shown in
A reveals that body of sponge is only faintly radiopaque, but marker
(arrow) is easily seen.
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Fig. 4. —Intraoperative radiograph obtained because of incorrect
sponge count in 54-year-old woman who underwent urethral suspension.
Radiopaque marker (arrow) of 4 x 4 inch (10 x 10 cm)
laparotomy sponge is visible in pelvis. Sponge was identified and removed.
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Fig. 5A. —Value of soft-copy image manipulation is illustrated in
radiographs obtained because of incorrect sponge count in 24-year-old woman
who underwent cesarean delivery. Original image settings result in generally
underpenetrated radiograph, and questionable density (arrow) is
faintly identified over left sacral ala.
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Fig. 5B. —Value of soft-copy image manipulation is illustrated in
radiographs obtained because of incorrect sponge count in 24-year-old woman
who underwent cesarean delivery. Radiograph shows that after digital
manipulation of window width and window level, marker (arrow) of 4
x 4 inch (10 x 10 cm) sponge is identified.
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Fig. 6A. —Importance of scrutinizing periphery of image is illustrated
in radiographs obtained in 62-year-old woman after abdominal aortic aneurysm
repair. Initial radiograph shows partially imaged laparotomy sponge marker
(arrow) at edge of image.
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Fig. 6B. —Importance of scrutinizing periphery of image is illustrated
in radiographs obtained in 62-year-old woman after abdominal aortic aneurysm
repair. Second radiograph centered to include more of left side of abdomen
shows three additional sponge markers (arrow). Sponges were
surgically removed.
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Fig. 7A. —Retained sponge in 30-year-old woman after right
hemicolectomy and partial small-bowel resection for Crohn's disease.
Fistulograms were requested 2 weeks after surgery because of wound dehiscence
and discharge. Image shows contrast material flowing into small opening in
lower part of wound and fistula passing superiorly around marker (straight
arrow) of retained 4 x 4 inch (10 x 10 cm) surgical sponge,
ending in communication with biliary tract, and draining to duodenum
(curved arrow).
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Fig. 7B. —Retained sponge in 30-year-old woman after right
hemicolectomy and partial small-bowel resection for Crohn's disease.
Fistulograms were requested 2 weeks after surgery because of wound dehiscence
and discharge. Magnified image of retained sponge shown in A reveals
sponge marker in greater detail.
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Fig. 8A. —Retained laparotomy sponge in 56-year-old man after radical
prostatectomy. Scout radiograph shows marker (arrow) of retained
sponge in pelvis.
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Fig. 8B. —Retained laparotomy sponge in 56-year-old man after radical
prostatectomy. Axial CT image shows sponge anterior to bladder. Beam-hardening
artifact is noted around marker (arrow).
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Fig. 9A. —Retained sponge in 69-year-old man 4 weeks after aortofemoral
bypass. Radiograph obtained to check position of feeding tube shows marker
(arrow) of retained laparotomy sponge in central abdomen.
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Fig. 9B. —Retained sponge in 69-year-old man 4 weeks after aortofemoral
bypass. Axial CT image confirms presence of retained sponge (arrow)
anterior to transverse colon.
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Fig. 9C. —Retained sponge in 69-year-old man 4 weeks after aortofemoral
bypass. Axial CT image obtained at level inferior to B shows fluid
collection (arrow). Sponge was removed surgically, and adjacent
collection was drained and found to be an abscess.
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Fig. 10. —Photograph of absorbable hemostatic sponge made of oxidized
reabsorbable cellulose (Surgicel; Ethicon, Somerville, NJ).
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Fig. 11. —CT scan obtained because of fever 3 months after bilateral
salpingo-oophrectomy for tuboovarian abscess in 43-year-old woman. Axial CT
image shows ill-defined soft-tissue density mass (arrow) with mottled
lucent center in left lower quadrant. Review of operative note confirmed
absorbable hemostatic sponge (Gelfoam, Pharmacia and Upjohn, Kalamazoo, MI;
Surgicel, Ethicon, Somerville, NJ) had been used to control bleeding in left
pelvis. Mass was considered to represent residual absorbable sponge and
gradually resolved on subsequent serial CT scans (not shown).
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Fig. 12. —CT scan obtained because of fever 8 days after total
abdominal hysterectomy, bilateral salpingo-oophrectomy, and debulking of stage
III ovarian cancer in 43-year-old woman. Mixed gas, fluid, and soft-tissue
density mass (arrows) with appearance similar to bowel are seen in
right pelvis, but no communication with bowel could be established on
contiguous images (not shown). Review of operative note confirmed absorbable
hemostatic sponge (Surgicel; Ethicon, Somerville, NJ) had been used to control
bleeding in pelvis. CT-guided aspiration yielded sterile serosanguineous
fluid. Mass was considered to represent residual absorbable sponge.
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Fig. 13. —CT scan obtained because of pain 5 days after total abdominal
hysterectomy for leiomyomata in 35-year-old woman. Mixed gas, fluid, and
soft-tissue density mass (arrows) are seen in central pelvis. Review
of operative note confirmed absorbable hemostatic sponge (Gelfoam; Pharmacia
and Upjohn, Kalamazoo, MI) had been used to control bleeding in pelvis. Mass
was considered to represent residual absorbable sponge and was not visible on
CT scan obtained 6 weeks later.
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Fig. 14A. —MR images of retained sponge obtained in 56-year-old man who
complained of urinary frequency 5 months after radical retropubic
prostatectomy. Axial spin-echo T1-weighted MR image (TR/TE, 500/15) after
injection of contrast material shows that sponge is identified as low-signal
structure anterior to contrast-filled bladder. Peripheral enhancement of
thick-walled capsule (arrow) is noted.
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Fig. 14B. —MR images of retained sponge obtained in 56-year-old man who
complained of urinary frequency 5 months after radical retropubic
prostatectomy. Axial fast spin-echo T2-weighted MR image (4000/105) shows
"whirled" configuration of sponge body (arrow). Sponge
was surgically removed.
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Copyright © 2003 by the American Roentgen Ray Society.
