Mistaking radiopaque material for a surgical instrument on pre- versus postoperative X-rays: Two case reports

Introduction: Postoperative abdominal X-ray is helpful for examining for remains in the abdominal cavity. We mistook radiopaque material for a surgical instrument in a comparison of pre- and postoperative X-rays.Case 1: A 48-year-old woman with uterine myoma underwent total laparoscopic hysterectomy (TLH). The postoperative abdominal X-ray revealed a high-intensity shadow in the pelvis, whereas the X-ray taken 15 days preoperatively did not. We were concerned that a surgical instrument was left during surgery. The patient's family said that she had undergone an upper gastrointestinal examination 6 days preoperatively. We thus determined that barium had remained in the appendix.Case 2: A 46-year-old woman with uterine adenomyosis underwent TLH. A postoperative abdominal X-ray revealed a clip-like shadow in the pelvis, but we had not used any clips during surgery. Because no shadow was visible in the abdominal X-ray taken 1 day preoperatively, we were concerned that a surgical tool remained within the abdominal cavity. When we reexamined her pelvis, a surgical assistant found the shadow of a clip in another X-ray taken before surgery. The shadow of the clip was located behind the iliac bone on the first X-ray image. The patient had undergone a laparoscopic appendectomy at 25 years of age, and we concluded that the clip within her abdomen was used during that surgery.Conclusion: We reaffirmed the importance of taking a detailed preoperative history of examinations, surgeries, and surgical procedures.