Intra-abdominal abscess and intractable sinus - a rare late complication after splenectomy

Abstract

Intra-abdominal abscess and an intractable abdominal wall sinus forty years after splenectomy is rare, which has not been described previously in the surgical literature. We report the management of a patient who had presented with an intractable sinus on his left hypochondrium forty years after having undergone splenectomy and cholecystectomy, which persisted for more than two years despite repeated surgery and courses of antibiotics and compromised quality of life significantly from pain. A sinogram and computerised tomographic scan followed by exploration and laying open of the sinus delivered multiple silk sutures used for ligation of splenic pedicle, led to complete resolution of the sinus. It is important to avoid using non-absorbable silk sutures during splenectomy when splenectomy is undertaken in a contaminated field. Appropriate imaging and exploration is mandatory for its resolution.

Keywords: Abscess; Intractable; Late presentation; Splenectomy; Sinus

Core tip: An intra-abdominal abscess and a sinus 40 years following splenectomy is rare, which should be investigated with a computerised tomographic scan and a sinogram and treated by exploration. Non-absorbable silk sutures, which act as nidus for bacteria, should be avoided if splenectomy is undertaken simultaneously with surgery on a hollow viscus.