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|Year : 1980 | Volume
| Issue : 4 | Page : 261-2
Intraperitoneal omental abscess following inguinal herniorrhaphy.
Vaze ML, Dewoolkar VV, Bhide PD, Dalvi UR, Bhagtani KC
|How to cite this article:|
Vaze M L, Dewoolkar V V, Bhide P D, Dalvi U R, Bhagtani K C. Intraperitoneal omental abscess following inguinal herniorrhaphy. J Postgrad Med 1980;26:261
|How to cite this URL:|
Vaze M L, Dewoolkar V V, Bhide P D, Dalvi U R, Bhagtani K C. Intraperitoneal omental abscess following inguinal herniorrhaphy. J Postgrad Med [serial online] 1980 [cited 2020 Apr 10];26:261. Available from: http://www.jpgmonline.com/text.asp?1980/26/4/261/943
Many complications have been described after inguinal herniorrhaphy in the text books of surgery, but lately we have encountered an unusual late complication. This complication has not been mentioned in the published literature.
A 20 year old male patient attended the outdoor department of the K.E.M. Hospital in December 1977 with the complaints of a lump in the left iliac fossa for the last 10 months. The patient gave history of undergoing surgery for left inguinal hernia. He was operated upon in a private nursing home. The details of the operative findings were not available to us. Initially the lump was small in size and it went on increasing gradually. There were no other complains. The patient had an uneventful recovery after the initial surgery.
On physical examination, the patient was in fair general health. There was a non-tender intra-abdominal lump in the left iliac fossa, about 5 cm in diameter. The lump was adherent to the left herniorrhaphy scar. The consistency of the lump was hard. The lump had greater transverse mobility than in the vertical direction. The liver and the spleen were not palpable. There was no free fluid in the abdomen. The external genitalia were normal. The digital rectal examination was normal.
Haemoglobin was 14 gm%. Stool and urine examinations were normal. There was no occult blood detected in the stool examination. Sigmoidoscopy also did not reveal any abnormality. The barium enema was normal.
The right lower paramedian incision was taken. The greater omentum was seen to be crowding in the left iliac fossa. There was a hard-walled abscess in the greater omentum, which was firmly adherent to the sigmoid colon and to the parietal wall behind the scar of the hernia. The abscess was accidentally opined during the dissection of the mass off the colon, and about 20 ml of yellowish non-smelling pus was drained out.
The entire abscess cavity with the omentum was excised without damaging the sigmoid colon [Fig. 1]. On opening the abscess cavity eight linen sutures were found embedded in the wall [Fig. 2]. The peritoneal cavity was closed in layers. The post-operative period was uneventful.
The intra-abdominal omental abscess following herniorrhaphy is a rare late post-operative complication.
In the present case we feel that it was an omentocoele. The part of the omentum was excised and the blood vessels were ligated at places with linen. These linen sutures could have got infected, to form an abscess, due to imperfect sterilization of suture material. Because of administration of antibiotics post-operatively, the abscess has walled off from general peritoneal cavity and with the passage of time the swelling had developed dense adhesions with the surrounding structures like colon and anterior abdominal wall. There is another possibility that the adherence to scar might be due to the transfixation stitch which might have gone through the omentum.
The above complication is probably not seen often, due to good methods of sterilization, better and careful operative technique and aseptic theatre conditions.
This is not an infected abscess in the inguinal canal protruding at the internal iguinal ring to which the omentum is adherent but an abscess in the omentum freely moving along with it in the peritoneal cavity. Omentum was adherent to the internal ring, a little distance away from the abscess. There was no abscess where the sac was ligated. Hence it is unlikely that infection was in the posterior wall first, which later on got localized in the omentum. Thus a rare complication following herniorrhaphy is presented here.
We are thankful to the Dean, K.E.M. Hospital, Bombay, for permitting us to use hospital data and to publish this paper.