Suture granuloma of the abdominal wall with intra-abdominal extension 12 years after open appendectomy

摘要

Most complications after appendectomy occur within ten days; however, we report the unusual case of a suture granuloma twelve years after open appendectomy. The afebrile 75-year-old woman presented with slightly painful palpable mass in the right lower abdomen. There was no nausea and vomiting and the bowel movements were normal. She lost 10 kg during last three months 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 CT scan showed inhomogenous abdominal mass with minimal vascularization in the right lower abdomen 8.6 x 8 x 9 cm that communicate with abdominal wall. Abdominal wall was thickened, weak and bulging. Abdominal wall mass did not communicate with cecum and ascending colon. Complete excision of the abdominal wall mass was made via median laparotomy. Histopathological examination revealed granuloma with central abscess. This case report demonstrates that a preoperative diagnosis of abdominal wall mass after open appendectomy warrant the use of wide spectrum of diagnostic modalities and consequently different treatment options.