USG finding suggesting postpartum intrauterine forgotten gau
The following case has been reported in the journal Clinical Case Reports.

A 31‐year‐old woman had vaginal delivery complicated with grade III perineal tear 4 weeks ago. Several gauzes were temporarily inserted into the cervix and vagina for hemostasis during the repair procedure. On postpartum day 4, vaginal ultrasonography was performed, which was a routine procedure in this institute: At that time no abnormalities were recognized. The patient was discharged on postpartum day 5.

One month later, she visited for a routine postpartum examination. Vaginal examination revealed an odorous smelling, brown‐colored gauze in the vagina, which was pulled out. Although not confirmed, the gauze was localized in the vagina, with no parts being located within the cervical canal. Ultrasonography on postpartum day 4 was reviewed once again.

Acoustic shadow in the low intrauterine cavity was found, mimicking an “open fan”. An attenuation of ultrasound wave occurs when various substances with higher impedance difference exist in the interface.1 If this substance is located noncontinuously or has various thickness in the longitudinal scan direction, it may create an “open fan” like feature.

The authors believe that a gauze, being located in the lower intrauterine cavity to cervix, thus making a snake‐like shape, caused this “open fan” sign. The gauzed dropped to the vagina, which was found at the regular checkup at one month postpartum.

Learning Points:-
- Although gauze counting is regarded as the most essential way to prevent a forgotten gauze inside the body during surgery, incident may still occur.

- An “open fan sign” on ultrasonography may suggest intrauterine (forgotten) gauze in postpartum period and, thus, may become addition to prevent it.

- This ultrasound sign may be applicable to detect a forgotten gauze in any organ other than the uterus/cervix depending on the gauze location and its surrounding structures although we have not yet data for it.

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