Chronic Encapsulated Anterior Abdominal Wall Seroma Post Laparoscopic Intraperitoneal Onlay Mesh Repair for Incisional Hernia: A Case Report

Abstract

Seroma is a collection of serous fluid in a closed space and often occurs and difficult to treat after operation .Here we reported a case of chronic encysted seroma following intraperitoneal onlay mesh repair for incisional hernia of the anterior abdominal wall. A 65-year-old lady with history of midline laparotomy for benign gynaecological disease presented with a reducible incisional hernia over the lower anterior abdominal wall subsequently underwent laparoscopic intraperitoneal on lay mesh repair and had an uneventful post-operative recovery. She presented 4 months later with an irreducible swelling at the hernia repair site. Clinically, there was a 10x10cm swelling lateral to the midline scar. Cough impulse was negative. The clinical presentation was suggestive of a fluid collection and hence an aspiration was performed drawing hemorrhagic fluid consistent with a hematoma. The collection however recurred rapidly within a few weeks . A contrast enhanced computed tomography of the abdomen pelvis was then performed that revealed seroma with no intraperitoneal communication or recurrent hernia. She initially underwent recurrent aspiration which did not resolve the condition and underwent an excision of the anterior abdominal wall encapsulated lesion. Intraoperative findings revealed a superficial 10 x 10 cm encapsulated mass at the anterior abdominal wall which did not communicate with the peritoneal cavity. Histopathological examination revealed a chronic encysted seroma. Chronic seroma can be distressing for patients during postoperative period and may lead to many complications. Aim should be focused on intraoperative techniques to reduce the dead space and tissue dissection. Management for chronic postoperative seroma should be tailored individually.