Title
Massive swelling of Surgicel® Fibrillar hemostat after spinal surgery : case report and a review of the literature Massive swelling of Surgicel® Fibrillar hemostat after spinal surgery : case report and a review of the literature
Author
Faculty/Department
Faculty of Medicine and Health Sciences
Publication type
article
Publication
Stuttgart ,
Subject
Human medicine
Source (journal)
Minimally invasive neurosurgery / Polskie Towarzystwo Lekarskie. - Stuttgart
Volume/pages
54(2011) :5/6 , p. 257-259
ISSN
0946-7211
ISI
000301034600012
Carrier
E
Target language
English (eng)
Full text (Publishers DOI)
Affiliation
University of Antwerp
Abstract
Background: Oxidized regenerated cellulose is commonly used in many surgical fields as a hemostatic agent. Complications related to swelling or compression after application of small portions of Surgicel® Fibrillar have not yet been described. Patients: We report on a 65-year-old woman who was operated for a high-grade spinal stenosis at the L2-L3 level. Small portions of Surgicel® Fibrillar were used to control bleeding from the epidural venous plexus. The immediate postoperative course was uneventful. However, one day after surgery, the patient complained about progressive worsening pain at the operated level. A non-contrast lumbar CT scan showed no evidence of a postoperative hematoma or other complication. MR imaging showed a horseshoe-shaped mass compressing the dural sac at the operated level from posterior and both sides. Because we suspected a postoperative hematoma, the patient was re-operated. No hemorrhage was seen but instead we found large, swollen firm pieces of Surgicel® Fibrillar compressing the dural sac. These pieces were removed. Result: Postoperatively no neurological deficit or pain was present. Histological examination of the removed mass of Surgicel® Fibrillar revealed only the presence of blood, fibrin and an amorphous eosinophilic content. There was no sign of any inflammation. Conclusion: On the basis of this experience, we advise caution with the use of hemostatic agents during spinal surgery and - if used - strongly advise the removal of Surgicel® Fibrillar after the hemostasis has been achieved to avoid the development of complications due to a mass effect.
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