SHM Converge Scientific Abstract ePoster Gallery-Much Ado About Nothing: Fibrillar Mistaken for Splenic Abscess

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This case report describes a 69-year-old man with recent sigmoidectomy, colorectal anastomosis, and loop ileostomy who presented with coffee-ground emesis and abdominal pain. He was tachycardic and had marked leukocytosis and thrombocytosis. CT of the abdomen and pelvis showed esophageal wall thickening and a loculated gas-and-fluid collection in the lower spleen, concerning for a splenic abscess. He underwent percutaneous drainage, but the fluid contained no leukocytes, had a negative Gram stain, and did not grow organisms.<br /><br />Further evaluation with EGD identified a duodenal ulcer, and the patient improved after endoscopic and medical management. A multidisciplinary review concluded that the splenic “abscess” was not infectious, but instead represented fibrillar Surgicel (oxidized regenerated cellulose) used during his recent surgery. This hemostatic material can persist for up to 45 days and may trap air as it degrades, creating an imaging appearance that mimics an abscess.<br /><br />The report emphasizes that Surgicel can be mistaken for postoperative abscess on CT, potentially leading to unnecessary drainage and antibiotics. Imaging clues favoring hemostatic material include lack of enhancing walls and absence of a well-defined air-fluid level. MRI may help differentiate true abscess from degenerating Surgicel.<br /><br />The key lesson is to avoid anchoring on imaging alone and to interpret radiographic findings in the context of the patient’s surgical history and overall clinical picture.

Asset Subtitle

Bobby Thomas

Meta Tag

Author List Bobby Thomas, Joshua Aron, Nirali Sheth

Category Clinical Vignettes

Concept Splenic Abscess

Concept Surgicel

Concept Infective Endocarditis

Concept Cross-Sectional Abdominal Imaging

Concept Oxidized Regenerated Cellulose

Distinguished Non-Finalist

Presenter Organization Elmhurst Hospital Center

Presenting Author Bobby Thomas

Track Adult

Keywords

Surgicel

splenic abscess

postoperative imaging

CT scan

oxidized regenerated cellulose

duodenal ulcer

percutaneous drainage

colorectal surgery

air-fluid collection

hemostatic material

Splenic Abscess

Surgicel

Infective Endocarditis

Cross-Sectional Abdominal Imaging

Oxidized Regenerated Cellulose