A 67-year-old woman, allergic to contrast cysts and polypectomy, obese lumbar with Body Mass Index (BMI) 41, insulin-dependent type I diabetic, with a history of previous herniated face or face.
In 2004 the patient consulted for lipodystrophy and abdominal dermochalasia. She underwent surgery under general anesthesia to perform a low transverse abdominal dermolipectomy with umbilical vertical resection and transposition.
In the postoperative period, two aspiration drainages were left by counterincision and the wound was closed by planes of cutaneous flaps.
The abdominal piece removed weighed 5942 gr; this piece showed no histological changes.
During the immediate postoperative period, the patient maintained pre-therapy with abdominal bandage for 2 months and antibiotic treatment with intravenous ciprofloxacin 400gr every 12 hours for 12 days.
Drainages of approximately 100 cc per day presented seropositivity, which is why drainages were maintained for 15 days until output was low.
Once removed, the patient consulted due to a fluctuation in the dissection plane.
The clinical suspicion of congenital malformation was established by performing weekly evacuation punctures on two occasions, in each of which 50 cc of serous content were extracted.
No fever or other symptoms appeared at any time and the seroma was considered clinically resolved.
Two years later, the patient consulted due to an abdominal mass due to pain due to supraglottic stenosis.
During the examination, a glossal, bleb and depressible abdomen was observed, and the presence of a suprapubic enlargement with painful characteristics extending to both iliac crests was observed.
Abdominal ultrasound revealed the presence of a well-defined mass with heterogeneous echostructure, affecting the infraumbilical abdominal wall.
An abdominal wall magnetic resonance imaging (MRI) with gadolinium D.T.P.A in axial and sagittal planes was requested.
Median SE T1 and FSE T2 sequences showed a vesicular lesion located at an anterior plane to the abdominal rectuses and the external oblique, with suprap.6 cm location and dimensions of the external oblique.
The mass showed intermediate signal in T2 sequences and good delimitation with respect to plans.
FNAC was negative for cells.
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5 patient was reoperated under general anesthesia. Through a suprapneural incision, a superficial fibrotic contour was found.
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Once removed, hemostasis was performed and two aspiration drainages were left by counterincision.
The abdominal wall was closed in layers.
The first plan consisted of simple Polygyne 2/0 sutures applied in the cranio-antral stenosis direction, connecting the flap to the abdominal fascia.
With this maneuver we intend a correct distribution of the tension in the flap minimizing dead spaces and sliding.
A second suture plane serves to anchor the flap's subdermal edge at the caudal edge of the wound; Polyg fabric 3/0 inverted sutures were used.
Finally, we performed an intradermal suture with 3/0 PDS® in the cutaneous plane.
During and after surgery the patient received antibiotic treatment with Ciprofloxacin 400gr intravenously every 12 hours and pre-therapy with abdominal bandage.
Drainages showed a rate of around 100 to 150 cc per day, with sero-healing content.
The hospital stay was prolonged for this reason for 10 days and the drains were removed at 3 weeks.
Two years after excision of the pseudocyst, the patient had no new complications.
The abdominal contour is not very different from that presented before the removal of the pseudocyst, since it was only detectable by palpation.
Anatomopathological examination of the resection specimen described an oval tumor of 19.8 x 8 x 5.5 cm in diameter and 570 gr in weight, corresponding to a formation of scarce cystic tissue with fibrous adipose wall in the periphery.
The section showed a parietal thickness of 0.3 cm and was occupied by a light brownish material, sometimes red, which emanates in some sectors a fibrinous and macrocystic fluid with microcystic areas.
Microscopic examination revealed a pseudocystic formation consisting of a fibrous wall without epithelial lining and occupied in its lumen by a fibrous and fibrin material in the process of organization.
Some peripheral sectors presented foamy histiocytes as well as optically empty spaces corresponding to cholesterol crystals.
