Laparoscopic treatment of a subfascial haematoma following a Pfannenstiel laparotomy

Abstract

Objective To report the laparoscopic treatment of abdominal wall haematomas and to review the literature spanning 1976–99. Design Case report and Medline search using Winspirrs as search engine. Report A 50‐year‐old patient, with a large abdominal wall haematoma following an abdominal hysterectomy by Pfannenstiel incision, was treated by laparoscopy. Following CO2 insufflation and trocar insertion at the umbilicus, the diagnosis of a haematoma was confirmed by the bulging parietal peritoneum. Using an operative laparoscope, the peritoneum was entered close to the umbilicus and a haematoma of 750 ml was aspirated. Thorough examination did not reveal any remaining active bleeding. Clinical recuperation was spectacular and the patient was discharged 2 days later. Review Abdominal wall haematoma following Pfannenstiel incision is a rare complication, with reported incidences of 5%. The clinical diagnosis can be confirmed by ultrasound and computed tomographic (CT) scan, with sensitivities of 71% and 100%, respectively. Surgical treatment is limited to large haematomas because of secondary wound healing problems. Conclusion Since the laparoscopic treatment of wall haematomas is so easy and straightforward, we suggest that broadening the indications for surgery can be considered. This could moreover lead to a revision of the diagnostic accuracy of ultrasound and CT scan for smaller haematomas.