Unusual clinical course, Unusual or unexpected effect of treatment
Vasileios Vasilakis, Kristin Cook, Dorian Wilson
(Department of General Surgery, Morristown Memorial Hospital, Morristown, USA)
Am J Case Rep 2014; 15:526-529
The aim of this report is to present a new surgical approach in the definitive management of challenging cases of abdominal wall seroma following herniorrhaphy with mesh.
Case Report: We describe the case of a 56-year-old male with a 4-year history of a complex abdominal wall seroma. He had undergone fluid aspiration twice without success. On physical examination, the mass was supraumbilical and measured 15×10 cm. Computer tomography (CT) scan revealed a complex encapsulated formation overall measuring 10.1×17.3×17.3 cm in AP, transverse, and craniocaudal dimensions, respectively. In this case complete resection was not safe due to the anatomic relationship of the posterior aspect of the pseudocapsule and the mesh. Intraoperatively, the anterior and lateral aspects of the pseudocapsule were resected and an argon beam was used to scarify the residual posterior pseudocapsule and prevent recurrence. This technique was successful in preventing reaccumulation of the seroma.
Conclusions: Capsulectomy and scarification of the remnant pseudocapsule is an acceptable and safe surgical option for complex chronic abdominal wall seromas.
Keywords: Abdominal Wall - surgery, Chronic Disease, Diagnosis, Differential, Hernia, Ventral - surgery, Herniorrhaphy - adverse effects, Humans, Laparoscopy, Male, Middle Aged, Seroma - surgery, Surgical Mesh - adverse effects, Tomography, X-Ray Computed