Lipogranulema of the hernia sac. Clinical case

Abstract

Lipogranulomas in surgical practice, are the most often encountered in the mammary glands, penis and facial area associated with subcutaneous injections for cosmetic purposes of various types of fillers that cause chronic granulomatous inflammation. Atypical localization occurs due to the development of reactions to foreign bodies after traumatic injuries and reactions to suture material used in surgical interventions. The article presents a clinical case of revealing a large peritoneal lipogranuloma localized in the area of the hernial sac in a patient who 7 years ago suffered from endometrial cancer and underwent extirpation of the uterus using median incision access. Subsequently, the patient was treated for a long time in an outpatient care because of the ligature abscesses with the formation of fistulas; several rough ligatures were removed from the subcutaneous tissue. Lipogranuloma, found in the wall of the hernial sac measuring 15 × 6 × 5 cm, covered from all sides with an unaltered peritoneum, contained a cystic cavity with a light fluid, thick synthetic ligatures of a braided structure were present in the cyst wall. The use of large-diameter braided non-absorbable sutures for suturing the peritoneum does not meet modern requirements for the use of suture material and can cause complications.