Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2017; 5(1): 14-17
Published online Jan 16, 2017. doi: 10.12998/wjcc.v5.i1.14
Intra-abdominal abscess and intractable sinus - a rare late complication after splenectomy
Badri Shrestha, James Hampton
Badri Shrestha, James Hampton, Sheffield Teaching Hospitals NHS Trust, Sheffield S5 7AU, United Kingdom
Author contributions: Both authors contributed to the acquisition of data, writing, and revision of this manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at Sheffield Teaching Hospitals NHS Trust.
Informed consent statement: The patient involved in this study gave his written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Badri Shrestha, MD, FRCS, FACS, Sheffield Teaching Hospitals NHS Trust, Herries Road, Sheffield S5 7AU, United Kingdom.
Telephone: +44-79-49354709 Fax: +44-11-42714604
Received: August 15, 2016
Peer-review started: August 16, 2016
First decision: September 28, 2016
Revised: October 2, 2016
Accepted: November 1, 2016
Article in press: November 2, 2016
Published online: January 16, 2017

Intra-abdominal abscess and an intractable abdominal wall sinus forty years after splenectomy is rare, which has not been described previously in the surgical literature. We report the management of a patient who had presented with an intractable sinus on his left hypochondrium forty years after having undergone splenectomy and cholecystectomy, which persisted for more than two years despite repeated surgery and courses of antibiotics and compromised quality of life significantly from pain. A sinogram and computerised tomographic scan followed by exploration and laying open of the sinus delivered multiple silk sutures used for ligation of splenic pedicle, led to complete resolution of the sinus. It is important to avoid using non-absorbable silk sutures during splenectomy when splenectomy is undertaken in a contaminated field. Appropriate imaging and exploration is mandatory for its resolution.

Keywords: Abscess, Intractable, Late presentation, Splenectomy, Sinus

Core tip: An intra-abdominal abscess and a sinus 40 years following splenectomy is rare, which should be investigated with a computerised tomographic scan and a sinogram and treated by exploration. Non-absorbable silk sutures, which act as nidus for bacteria, should be avoided if splenectomy is undertaken simultaneously with surgery on a hollow viscus.