Suture Granuloma Diagnosed and Treated With Bedside Ultrasound

Emergency physicians frequently evaluate patients with postoperative wound issues. The differential is broad, but obviously includes postoperative site infections. We present a case where a suspected postoperative abscess was evaluated with bedside ultrasound prior to incision and drainage. Suture material was recognized, shifting our approach to treatment of the lesion.

A 24-year-old female patient presented with pain, swelling, and drainage from a left lower quadrant abdominal wound that had been present since undergoing a laparoscopic appendectomy 1 year prior. A computed tomography scan was performed, which was negative for foreign bodies. Prior to incision and drainage, a bedside ultrasound was performed to evaluate the lesion, which was notable for sonographic findings consistent with suture material. Suture granuloma was diagnosed, and ultrasound was then used to successfully guide retrieval of the suture. To our knowledge, this is the first published case where ultrasound was used to both diagnose and dynamically remove the offending suture material. We briefly discuss suture granulomas, their sonographic appearance, and management. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians frequently perform ultrasound on suspected abscesses prior to incision and drainage and should be aware of the sonographic appearance of suture material as it would change management if present. If a suture granuloma is suspected due to swelling at a postoperative site, ultrasound use should be strongly considered for evaluation.