[Pre-peritoneal bisaccular umbilical and subcutaneous abscess after laparoscopic appendectomy]

Area of Science:

• Minimally invasive surgery
• Surgical site infections
• Abdominal wall abscess

Background:

• Laparoscopic surgery, including appendicectomy, has become a common surgical approach since the late 1980s.
• Transumbilical laparoscopic appendicectomy is a specific technique utilizing the umbilicus for port insertion.
• Post-operative complications, though infrequent, require thorough investigation and management.

Observation:

• A 36-year-old patient developed recurrent subumbilical pain after transumbilical laparoscopic appendicectomy.
• An hour-glass shaped abscess with preperitoneal and subcutaneous localization was evacuated 48 days post-operatively.
• The abscess was found at the umbilical trocar insertion site, with the infection presenting unusual distant pain localization.

Findings:

• The patient's clinical presentation of distant pain was an unusual manifestation of a surgical site infection.
• The hour-glass shape and the specific preperitoneal and subcutaneous location of the abscess at the umbilical site are atypical.
• Epiploic reaction played a role in blocking the abscess formation.

Implications:

• This case underscores the potential severity of post-operative abdominal wall abscesses following laparoscopic procedures.
• It emphasizes the critical need for robust prophylactic strategies to prevent such infections.
• Further research into risk factors and prevention of unusual surgical site infections is warranted.