Transvaginal sonographic appearance of Surgicel®: A case series report

Abstract

Background: Surgicel® (oxidized regenerated cellulose) is widely used for hemostasis in gynecological surgery. Although intended to be absorbed within weeks, it can persist and be visualized on transvaginal ultrasound, potentially mimicking ovarian pathologies. The purpose of this study was to describe the appearance of Surgicel® on post-ovarian cystectomy and provide guidance on differentiating it from other conditions. Methods: We retrospectively reviewed postoperative transvaginal sonographic examinations of 6 patients after laparoscopic ovarian cystectomy in which Surgicel® was used for hemostasis. Ultrasonographic evaluations were performed as part of routine postoperative assessment without any specific timing protocol. Sonographic examinations were performed up to 335 days after surgery. Images were reviewed for echogenicity, vascularization (color doppler) and acoustic properties. Surgical reports confirmed the use of Surgicel®in each patient. Results: Surgicel® displayed varying ultrasonographic characteristics, lacking a uniform appearance. In all cases, it appeared as a hyperechoic, avascular lesion, sometimes with posterior acoustic shadowing and occasionally accompanied by a cystic component. In one patient, serial scans revealed a gradual reduction in size and changes in sonographic features over time. Conclusion: Surgicel® can present with diverse ultrasound features. However, a hyperechoic avascular lesion is a key potential sign for distinguishing it from other conditions. Awareness of these sonographic appearances is essential to avoid misdiagnosis, highlighting the importance of collaboration between sonographers and surgeons to prevent unnecessary interventions.

Keywords

• Surgicel®
• Oxidized regenerated cellulose
• Ultrasound
• Gynecology
• Hemostatic agents
• Case series