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Background
Morel-Lavallee seroma (MLS) or post-traumatic pseudocyst signifies a closed degloving injury often a result of a severe, traumatic, shearing injury, causing separation of the skin and subcutaneous tissue from the underlying deep fascia ( figure 1 ). Though well described in the orthopaedic trauma literature, this lesion is not well recognised by the general surgeons in a polytrauma setting. Presently this injury has been well-described for trochanteric, gluteal and knee 1-4 but lesion involving sacral, lumbar and thoracic area of back and bilateral flanks has to best of our knowledge not been mentioned in literature. We describe a case of 18-year-old boy who was referred to general surgery department of King George's Medical University India for back swelling following motor vehicle accident 2 weeks prior. Diagnosis and management of this lesion is challenging and needs to be addressed.
Case presentation
Eighteen years male weighing 65 kgs was referred to general surgery for symptom of large back swelling following motor vehicle accident. On interviewing, the patient developed a tender swelling in lower back immediately after the accident in which there was shear injury to the back ( figure 2 A, B) following fall along large tyre of vehicle, for which patient was admitted to another hospital for few days and improved on analgesics and antibiotics and subsequently discharged. Two weeks later patient noticed large non-tender swelling in back for which needle aspiration was performed in a private hospital after which he was referred to our tertiary care facility.
Investigations
After initial work up of the patient including physical examination, coagulation profile (within normal limits), serum and fluid albumin and protein levels (serum albumin=3.8 gm/dL, serum protein=6.5 gm/dL; fluid biochemistry: fluid albumin=2.8 gm/dL, protein=4.1 gm/dL), high-resolution ultrasonography (USG) of back was performed which was suggestive of collection in subcutaneous tissue in superficial plane in almost entire extent of back extending from nape of neck to lower back on both sides of midline. Lymphangiography was performed to rule out lymphocele and abnormal vascular connections. MRI back was suggestive of subcutaneous collection with septations extending in thoracic, lumbar and sacral region (hyperintense collection with septations) ( figure 2 C, D).
Treatment
Percutaneous aspiration was performed and 2 L of serous fluid was aspirated followed by repeat aspiration after...