Intra-abdominal etiology of post-abdominoplasty pain: report of 2 cases

Abdominoplasty is a commonly performed body-contouring procedure with a predictable postoperative course. Early abdominal pain is typically attributed to surgical site discomfort, edema, rectus plication, or common complications such as seroma or hematoma. However, intra-abdominal pathology may present with overlapping or nonspecific symptoms, increasing the risk of diagnostic delay. We report two cases of postoperative abdominal pain following abdominoplasty in which intra-abdominal etiologies were identified or strongly considered. In Case 1, a 71-year-old woman with prior Roux-en-Y gastric bypass developed progressive abdominal pain and obstructive symptoms on postoperative day 1. Imaging revealed small bowel obstruction, and diagnostic laparoscopy confirmed an internal hernia through a Petersen's defect requiring surgical intervention. In Case 2, a 34-year-old woman presented with progressive right lower quadrant pain and swelling after a combined reduction mammaplasty and abdominoplasty. Imaging demonstrated an incidental ovarian hemorrhagic cyst, and she was managed conservatively with resolution of symptoms. In both cases, the abdominal wall and surgical sites were clinically benign. These cases highlight that postoperative abdominal pain after abdominoplasty is not always attributable to the abdominal wall or operative field. Overlapping symptoms may contribute to diagnostic anchoring and delayed recognition of intra-abdominal pathology. Maintaining a broad differential diagnosis, particularly in patients with prior abdominal surgery or atypical symptom progression, is essential. Prompt evaluation and multidisciplinary collaboration can reduce morbidity and prevent delays in care.