title: Suture granuloma of the abdominal wall with intra-abdominal extension 12 years after open appendectomy.
abstract: Most complications after appendectomy occur within ten days; however, we report the unusual case of a suture granuloma 12 years after open appendectomy. The afebrile 75-year-old woman presented with a slightly painful palpable mass in the right lower abdomen. There was no nausea or vomiting and bowel movements were normal. She lost 10 kg during the 3 mo before presentation. The patient had undergone an appendectomy 12 years previously. Physical examination revealed a tender mass, 10 cm in diameter, under the appendectomy scar. The preoperative laboratory findings, tumor markers and plain abdominal radiographs were normal. Multi-slice computed tomography scanning showed an inhomogenous abdominal mass with minimal vascularization in the right lower abdomen 8.6 cm x 8 cm x 9 cm in size which communicated with the abdominal wall. The abdominal wall was thickened, weak and bulging. The abdominal wall mass did not communicate with the cecum or the ascending colon. Complete excision of the abdominal wall mass was performed via median laparotomy. Histopathological examination revealed a granuloma with a central abscess. This case report demonstrates that a preoperative diagnosis of abdominal wall mass after open appendectomy warrants the use of a wide spectrum of diagnostic modalities and consequently different treatment options.
authors.affiliation: Department of Surgery, Division of Abdominal Surgery, University Hospital Center Zagreb, Kispatićeva 12, 10000 Zagreb, Croatia. augustin.goran@gmail.com
authors.forename: Goran
authors.initials: G
authors.lastname: Augustin
authors.forename: Dragan
authors.initials: D
authors.lastname: Korolija
authors.forename: Mate
authors.initials: M
authors.lastname: Skegro
authors.forename: Jasminka
authors.initials: J
authors.lastname: Jakic-Razumovic
mesh_terms: D000005:Abdomen / Q000473:pathology*; D000368:Aged; D001062:Appendectomy / Q000009:adverse effects*; D003106:Colon / Q000000981:diagnostic imaging / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006099:Granuloma / Q000175:diagnosis*; D006801:Humans; D011183:Postoperative Complications; D013530:Surgical Wound Infection / Q000175:diagnosis*; D013537:Sutures; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
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