Foreign bodies of the abdominal cavity
Foreign bodies in the abdominal cavity and pelvic cavity, as complications of surgical interventions, are a relatively rare complication and occur approximately after one of 100-500 operations. Up to 50% of all foreign bodies are hemostatic sponges and forgotten surgical swabs.
There are two types of reaction of the body to such foreign bodies.
In the first variant, the development of aseptic granulomatous inflammation occurs, there are no clinical manifestations, and the foreign body is detected as an accidental finding.
In the second variant, as a result of infection, an abscess is formed, which proceeds with the corresponding clinical picture (fever, changes in the blood test, etc.).
An important point is to determine the presence of a foreign body in the body and the ability to distinguish it from a "normal" abscess (in the latter case, repeated surgical intervention is not required).
If a foreign body is found in the patient's body, a relaparotomy (repeated surgical intervention) is performed.
Diagnosis of metal foreign bodies, surgical drains is successfully carried out using traditional radiography and ultrasound (ultrasound) and is not an indication for the use of computed tomography (CT). To clarify the location of a foreign body in an anatomically complex area and to better assess its relative position with anatomical structures, it is advisable to use the CT method.
The following is a clinical case:
Patient: L. 36 years old
Complaints on receipt: for discomfort in the mesogastrium.
Anamnesis of the disease. I independently discovered a volume formation in the mesogastrium. From the anamnesis, it is also known that the patient had three cesarean sections.
Examination at the pre-hospital stage:
EGDS: signs of antral reflux gastritis with the presence of single hemorrhages. Duodenoastric reflux.
Colonoscopy: without pathology.
Ultrasound of the abdominal organs: signs of chronic calculous cholecystitis.
FVD: normal spirometry.
Echocardiography: the heart chambers are not dilated. The ejection fraction is 64.8%.
ECG: sinus rhythm. EOS is normal. Heart rate 90 per minute.
USDG of the vessels of the lower extremities 24.03.16: echo signs of thrombo-occlusive lesion of the veins of the lower extremities were not detected.
figure 1-3According to the MSCT of the abdominal organs with intravenous contrast: signs of a volume formation at the level of the mesogastrium (middle floor of the abdominal cavity), associated with the wall of the small intestine (ileal diverticulum?).
The main one: Diverticulum of the ileum.
Complications: perforation of the diverticulum of the ileum. Abscess of the abdominal cavity.
Related: Chronic gastritis. Cholelithiasis: chronic calculous cholecystitis.
The patient was operated on as planned in the volume of laparoscopically-assisted resection of the small intestine. Laparoscopic cholecystectomy. Appendectomies. Enteroenterostomy. Drainage of the abdominal cavity.
During the operation, the patient revealed a volume formation located in the mesogastrium with involvement of the jejunum wall in several areas. When opening this formation, the presence of a foreign body (gauze napkin) was revealed.
From this clinical case, we can conclude:
for the diagnosis of a foreign body, it is extremely important to collect anamnesis indicating the previous surgical operation. If a patient is suspected of having a foreign body, MSCT allows visualizing gas bubbles with a diameter of 1.5 mm in the formation, assessing the degree of changes in the surrounding adipose tissue, the relationship of the foreign body with adjacent organs, and indirectly assessing the presence of blood flow in the suspicious formation.