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Background
Development of seroma after hernia repair is common, especially among patients undergoing laparoscopic or open ventral hernia repairs with prosthetic mesh. 1 It could represent a mere incidental finding causing minimal discomfort, or a complication requiring intervention. The incidence of seroma formation in patients undergoing ventral hernia repair is variable and reported at rates ranging from 0.5-78% after laparoscopic repair, and 30-50% after open repair. 2 3 The onset is typically during the early postoperative period, with resolution usually within 18-30 days. 1 In contrast, the onset is rarely delayed or accompanied by complications that pose a greater challenge in management. We report a case of seroma formation diagnosed 5 years after ventral incisional hernia repair (VIHR), and describe its management. To the best of our knowledge, this case represents the longest delay in onset reported in the English literature, with the as yet reported longest delay being 2 years. 3
Case presentation
A 44-year-old woman with a body mass index of 38 presented to the emergency department, with a 1 day history of discharge from a prior abdominal surgical incision. She reported of progressive abdominal fullness over the past several months. The patient denied fever, chills, nausea, vomiting, diarrhoea and constipation. Surgical history included an open Roux-en-Y gastric bypass surgery and umbilical hernia repair performed 7 years prior. This was complicated 2 years later by a ventral incisional hernia that was repaired using composite mesh, and abdominoplasty. Medical, family, drug and social history were unremarkable.
On examination, the patient had normal vital signs. The abdomen was distended and a left incisional wound lateral to the umbilicus was evident, with spontaneous and an expressible copious serous, yellowish, non-malodorous discharge. There was neither overlying calor nor erythaema. Complete blood count and basic metabolic panel were normal.
Investigations
CT of the abdomen and pelvis with contrast revealed a 29 cmx17 cmx13 cm abdominal fluid collection, extending from the epigastrium to the pelvic brim, and into the abdominal wall fascial layers and subcutaneous tissue, forming a pocket of fluid measuring approximately 9 cmx3 cm ( figure 1 ). A linear radiodensity was observed within the collection, representing a separated hernia mesh.
Treatment
The patient was provisionally diagnosed with late-onset seroma complicated by spontaneous drainage. Subsequently, incision and...