A Surgicel™ Surprise: Retained Oxidized Regenerated Cellulose Posing as a Biloma With Retained Gallstones After Subtotal Cholecystectomy.

Abstract

Surgicel™ is a bioabsorbable local hemostatic agent frequently used to control bleeding during laparoscopic cholecystectomy. Although rare, residual Surgicel™ can cause a local inflammatory response and subsequent calcification. This may complicate the interpretation of imaging studies, leading to misdiagnosis and unnecessary workup. Sixteen months after subtotal cholecystectomy for gangrenous cholecystitis, a 64-year-old man presented to the emergency department with epigastric pain. A CT of the abdomen demonstrated mild inflammation and a localized hyperdensity within the residual gallbladder, suggestive of biloma and retained gallstones. However, a subsequent hepatobiliary iminodiacetic acid scan showed normal post-cholecystectomy changes, ruling out biloma. Accordingly, the patient's clinical presentation and initial radiologic findings were consistent with calcification of retained Surgicel™. Calcification of Surgicel™ is rare and radiographically mimics gallstones. A thorough evaluation of the patient's complete operative history is critical to avoid misdiagnosis and unnecessary interventions.