Leftover Silk Suture Triggers Rare Abdominal Abscess Two Years After Appendectomy, Recent Case Report

These findings from the case report are published in the Journal of Minimal Access Surgery by Digant Pathak from the Jabalpur Hospital and Research Centre and colleagues.

The case is highly significant for modern clinical practice because it highlights a rare diagnostic pitfall where a benign suture complication closely mimics a more concerning abdominal mass. It emphasizes that surgeons must maintain a broad differential diagnosis when evaluating pediatric patients who present with unexplained abdominal symptoms long after undergoing minimally invasive surgery. Recognizing these delayed presentations ensures that clinicians can avoid misdiagnosing the condition as an oncological recurrence or an active inflammatory bowel disease.

A seven-year-old male pediatric patient presented with a five-day history of central abdominal pain and fever two years after a laparoscopic appendectomy, leading to diagnostic ultrasound and contrast-enhanced computed tomography examinations that identified a thirty-milliliter localized fluid collection in the rectus sheath. Subsequent diagnostic laparoscopy revealed dense pelvic adhesions of the terminal ileum and caecum near the previous port site, which allowed for the successful surgical removal of the culprit non-absorbable silk suture from the abscess cavity and resulted in an uneventful recovery with the child remaining completely asymptomatic at his one-year clinical follow-up.

The underlying mechanism of this late complication is driven by a chronic foreign body giant cell reaction to the non-absorbable silk suture material used to transfix the appendiceal stump during the primary operation. This persistent, low-grade inflammatory response over two years led to the formation of a suture granuloma, which subsequently liquefied and presented as a late-onset abscess cavity.

The case highlights the clinical importance of recognizing suture-induced granulomas, historically referred to as Schloffer tumors, as a potential differential diagnosis for any late-onset abdominal mass after pediatric surgery. It also suggests that future patient care could be improved by utilizing less invasive ultrasound-guided localization and retrieval of infected sutures as an alternative to repeating a full laparoscopy or laparotomy.

Reference

Pathak D, Gupta N, Manchanda V. Late intra-abdominal abscess after laparoscopic appendectomy in a child. J Min Access Surg. 2026;22(3):321-322.