Delayed Diagnosis of Small Bowel Perforation following Abdominal Liposuction

Although abdominal liposuction is generally considered a safe and widely performed cosmetic procedure, rare but serious complications, including visceral injury, have been reported. We report a case of delayed diagnosis of small bowel perforation after abdominal liposuction, resulting in intra-abdominal abscess formation that required emergency surgery. This case highlights that bowel perforation may remain clinically silent during and immediately after liposuction, leading to delayed diagnosis.

A 55-year-old Japanese woman presented with abdominal pain following abdominal liposuction. The patient had a history of 2 cesarean sections and no other significant medical history. During the liposuction procedure, no abnormal vital signs or operative findings were observed. Mild abdominal pain was noted on POD 1 and was initially considered to be postoperative pain related to liposuction. However, the symptoms progressively worsened, prompting the patient to present to our hospital on POD 6. Physical examination revealed localized rebound tenderness in the left lower abdomen. CT revealed a localized fluid collection containing gas around an edematous segment of the small intestine, consistent with an intra-abdominal abscess secondary to small bowel perforation. Emergency surgery revealed a localized abscess and a solitary 3-mm ileal perforation. We performed abscess drainage and partial small bowel resection. Histopathological examination revealed granulation tissue formation and marked fibroblast proliferation around the perforation site, suggesting that the perforation had occurred several days earlier. No other pathological findings or foreign bodies were observed. Based on the clinical course and pathological findings, liposuction was considered the most plausible explanation for the small bowel perforation, although a direct causal relationship could not be definitively established. The patient's postoperative course was uneventful.

Although rare, abdominal liposuction can result in visceral injuries such as bowel perforation. Depending on the severity of the injury, diagnosis may be delayed, leading to severe or potentially fatal consequences. Surgeons should maintain a high index of suspicion for visceral injury when evaluating patients with abdominal pain following liposuction.