10/2/2023 0 Comments Serosanguinous fluid after surgery![]() A large horseshoe-shaped seroma in the anterior abdominal wall anterior to the rectus abdominis of similar size was again noted (Figure (Figure2). The gallbladder contained multiple small calculi. The CT abdomen revealed an obstructed biliary tree with a distal common bile duct (CBD) calculi and dilated CBD of 10 mm. Blood culture and urine culture had no growth and chest X-ray did not show pneumonia. She had deranged liver function tests with a total bilirubin of 45 µmol/L, alanine aminotransferase (ALT) 133 U/L, gamma-glutamyl transferase (GGT) 548 U/L, and alkaline phosphatase (ALP) of 209 U/L. Laboratory investigations revealed raised inflammatory markers with leucocytosis (13.83*109/L) and C-reactive protein (CRP) of 430 mg/L. There were no signs of cellulitis on the abdominal wall. She was tender in the epigastric and right upper quadrant with a positive Murphy’s sign. Clinically, she did not appear jaundiced. On examination, she was febrile to 38.2˚C and other vital observations were normal. Axial view on left, midline sagittal view on the right. Pre-op CT abdomen prior to incisional hernia repair. After discussion with the patient and her treating surgeon, it was decided not to be treated as there was a potential risk of introducing infection which might lead to mesh explantation in the worst-case scenario. A CT abdomen done as part of colon cancer surveillance four months after repair incidentally showed a large seroma (Figure (Figure1) 1) but she was asymptomatic and had no signs of infection. ![]() She had undergone an open incisional hernia repair with mesh placement in the retro-rectus plane (Rives-Stoppa) in November 2019, a year prior to the current presentation. She developed a large midline incisional hernia with intestinal content a year after right hemicolectomy. Significant past medical history includes previous open right hemicolectomy secondary to low-grade mucinous appendiceal neoplasm, asthma, type 2 diabetes mellitus, chronic kidney disease, gastroesophageal reflux, hypertension, previous hysterectomy, osteoarthritis, and morbid obesity with a BMI of 43. A female in her 70s presented with a four-day history of fevers, right upper quadrant and epigastric abdominal pain associated with vomiting, loose stools, and dark urine.
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