Laparoscopic treatment of a subfascial haematoma following a Pfannenstiel laparotomy

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 followi ng an abdominal hysterectomy by Pfannenstiel incision, was treated by lapar oscopy. Following CO2 insufflation and trocar insertion at the umbilicus, t he diagnosis of a haematoma was confirmed by the bulging parietal peritoneu m. 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 specta cular and the patient was discharged 2 days later. Review Abdominal wall haematoma following Pfannenstiel incision is a rare c omplication, with reported incidences of 5%. The clinical diagnosis can be confirmed by ultrasound and computed tomographic (CT) scan, with sensitivit ies of 71% and 100%, respectively. Surgical treatment is limited to large h aematomas because of secondary wound healing problems. Conclusion Since the laparoscopic treatment of wall haematomas is so easy a nd 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.