title: Massive swelling of Surgicel® Fibrillar™ hemostat after spinal surgery. Case report and a review of the literature.
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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium. tomas.menovsky@uza.be
authors.forename: T
authors.initials: T
authors.lastname: Menovsky
authors.forename: M
authors.initials: M
authors.lastname: Plazier
authors.forename: R
authors.initials: R
authors.lastname: Rasschaert
authors.forename: A I R
authors.initials: AI
authors.lastname: Maas
authors.forename: P M
authors.initials: PM
authors.lastname: Parizel
authors.forename: S
authors.initials: S
authors.lastname: Verbeke
mesh_terms: D000368:Aged; D002483:Cellulose, Oxidized / Q000009:adverse effects*; D020878:Device Removal; D005260:Female; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000379:methods; D006490:Hemostatics / Q000009:adverse effects*; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008159:Lumbar Vertebrae / Q000601:surgery*; D013117:Spinal Cord Compression / Q000209:etiology* / Q000601:surgery; D013130:Spinal Stenosis / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D002483:Cellulose, Oxidized; D006490:Hemostatics; C013695:Surgicel