Peer-reviewedCC BY 4.0Case Reports in Surgery4 Nov 2026

FloSeal Related Small Bowel Obstruction: A Word of Caution

Gavin J. Carmichael^1,2,3
Jessica E. Hanna^2,3,4
Daniel Ng Ying Kin^2,3
Mathew O. Jacob^2,3,4,5

5 affiliations

¹Adelaide University Adelaide South Australia Australia adelaide.edu.au
²Grampians Health Ballarat Victoria Australia
³Grampians Research Initiative Ballarat Victoria Australia
⁴Deakin University Ballarat Victoria Australia deakin.edu.au
⁵University of Melbourne Melbourne Victoria Australia unimelb.edu.au

Abstract

Topical haemostatic agents such as FloSeal are widely used to manage low‐grade bleeding in areas where conventional haemostatic techniques may risk damage to critical structures or are unsuccessful. While effective, these agents can cause unexpected complications. This case report highlights small bowel obstruction (SBO) as a rare but important adverse outcome following FloSeal use in colorectal surgery. A 55‐year‐old male underwent laparoscopic right hemicolectomy for hepatic flexure adenocarcinoma. Due to raw surface oozing near Gerota’s fascia and proximity to the duodenum, FloSeal was applied intra‐operatively. On postoperative day 3, the patient developed nausea, absent flatus and bowel sounds and a rising C‐reactive protein (CRP) (366 mg/L), progressing to 540 mg/L by day 4. CT imaging showed ileus with an intact anastomosis and no closed‐loop features. Exploratory laparotomy identified a transition point where the distal ileum was adhered to residual FloSeal, resulting in a high‐grade obstruction. Following adhesiolysis and irrigation, the patient recovered uneventfully. Normal lactate and a negative septic screen argued against bacterial translocation with systemic sepsis as the driver of the CRP rise, suggesting instead a localised inflammatory response to mechanical obstruction. We frame this as a preventable, surgical technique‐related complication rather than an intrinsic hazard of FloSeal, arising from a deliberate deviation from manufacturer instructions to remove excess material. Surgeons should maintain a high index of suspicion for SBO in patients with rising CRP and no radiological leak, and should clearly document whenever haemostatic material is deliberately retained.

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Cite

BibTeX RIS

BibTeX

@article{carmichael2026floseal,
  title = {{FloSeal Related Small Bowel Obstruction: A Word of Caution}},
  author = {Gavin J. Carmichael and Jessica E. Hanna and Daniel Ng Ying Kin and Mathew O. Jacob},
  journal = {Case Reports in Surgery},
  year = {2026},
  month = nov,
  doi = {10.1155/cris/1127650},
  url = {https://doi.org/10.1155/cris/1127650},
  note = {CC BY 4.0},
}

RIS

TY  - JOUR
TI  - FloSeal Related Small Bowel Obstruction: A Word of Caution
AU  - Gavin J. Carmichael
AU  - Jessica E. Hanna
AU  - Daniel Ng Ying Kin
AU  - Mathew O. Jacob
PY  - 2026
DA  - 2026/11/04
JO  - Case Reports in Surgery
DO  - 10.1155/cris/1127650
UR  - https://doi.org/10.1155/cris/1127650
AB  - Topical haemostatic agents such as FloSeal are widely used to manage low‐grade bleeding in areas where conventional haemostatic techniques may risk damage to critical structures or are unsuccessful. While effective, these agents can cause unexpected complications. This case report highlights small bowel obstruction (SBO) as a rare but important adverse outcome following FloSeal use in colorectal surgery. A 55‐year‐old male underwent laparoscopic right hemicolectomy for hepatic flexure adenocarcinoma. Due to raw surface oozing near Gerota’s fascia and proximity to the duodenum, FloSeal was applied intra‐operatively. On postoperative day 3, the patient developed nausea, absent flatus and bowel sounds and a rising C‐reactive protein (CRP) (366 mg/L), progressing to 540 mg/L by day 4. CT imaging showed ileus with an intact anastomosis and no closed‐loop features. Exploratory laparotomy identified a transition point where the distal ileum was adhered to residual FloSeal, resulting in a high‐grade obstruction. Following adhesiolysis and irrigation, the patient recovered uneventfully. Normal lactate and a negative septic screen argued against bacterial translocation with systemic sepsis as the driver of the CRP rise, suggesting instead a localised inflammatory response to mechanical obstruction. We frame this as a preventable, surgical technique‐related complication rather than an intrinsic hazard of FloSeal, arising from a deliberate deviation from manufacturer instructions to remove excess material. Surgeons should maintain a high index of suspicion for SBO in patients with rising CRP and no radiological leak, and should clearly document whenever haemostatic material is deliberately retained.
SN  - 2090-6900
SN  - 2090-6919
ER  -