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Suggest treatment for recurring seromas

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Posted on Mon, 13 Oct 2014
Question: I am a 49 year old who had Robotic Salpingo-Oophorectomy in December. Since then I have had recurring seromas in the right port site. 2 seromas have been excised surgically. The third was treated through months of needle aspiration to no avail. It is still there and has become thickly enwalled and attached to the fascia. Need surgery again to remove it. Question is that my dr does not seem to understand how strong my pain is on the right side, which sometimes come on stronger than normal - like a sharp stabbing pain that radiate down to my thigh, right hip,and back. What could be the cause? Could there be a hernia beneath the seroma from the port entry?
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Answered by Dr. Shoaib Khan (1 hour later)
Brief Answer:
Infections and hernia are possibilities ma'am

Detailed Answer:
Hello ma'am and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. I should rightfully start by informing you that seromas, and especially recurrent seromas after surgery can make the surgical site susceptible to infection and structural breakdown of the site.

That being said, the symptoms of an infection are severe pain (something your doctor should be looking out for), fever, increased heart rate, etc. Either way, the best approach to treatment would be the surgical approach including excavation, debridement, drainage and adequate irrigation of the surgical site.

Of course, other than infections we should also adequately rule out possible herniation due to the surgery conducted, but this can also be addressed if found during the surgical excavation. So it would be wise to go ahead with the surgical procedure at the earliest, as I understand how the pain you are experiencing can be excruciating and highly frustrating.

I hope you find my response helpful. Please feel free to write back to me for any further clarifications, I would be more than happy to help you.

Best wishes.
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Shoaib Khan (25 hours later)
Thank you so much for the response. Would the hernia not sow up in the many (4) ct scans and numerous ultrasounds done during aspirations? Or could it be hidden beneath thickly enwalled seroma. Of main concern is the pain that sharp in nature and radiates down toward thigh, right hip and low back pain. Best described as a knife being thrust. Surgeon doesnt understand pain but will excise seroma, scar tissue and look for hernia (since this was a port site) from first robotic assisted surgery and hopefully for any fistula that could be leading to build up of serous fluid. Any reco or suggestions of queations to ask my surgeon would be appreciated. Just wanting XXXXXXX lif. e
doctor
Answered by Dr. Shoaib Khan (53 minutes later)
Brief Answer:
Just the pain needs to be addressed

Detailed Answer:
Hello once again ma'am.

I completely understand ma'am, but you should know that there could be various causes for the pain and your doctor will have to look into this. Causes can include iatrogenic injury to blood vessels, possible infection, fistula formation, compression by surgical site onto surrounding blood vessels, etc. Your doctor will have to pay attention to this symptom and address it accordingly.

We would not want to pain to continue to persist even after corrective surgery this time, because if at all it is then another procedure might be warranted. So please make sure you tell your doctor that you need the pain to be adequately addressed this time.

As for the hernia, it should have been visualized on the CT scans and ultrasound investigations conducted, no matter how deep-seated it is. So we can almost completely rule out hernias thanks to the CT scans and ultrasound investigations.

Other than this, there is nothing of much importance right now. A patient in pain is one we have not completely treated, so your pain should disappear after the upcoming surgical procedure, so my only suggestion to you is to make it very clear to your doctor that the pain needs to be addressed.

I hope and pray for your complete recovery. Please feel free to write back to me for any further clarifications, I would be more than happy to help you.

Best wishes.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Dr. Shoaib Khan

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Practicing since :2009

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Suggest treatment for recurring seromas

Brief Answer: Infections and hernia are possibilities ma'am Detailed Answer: Hello ma'am and welcome. Thank you for writing to us. I have gone through your query with diligence and would like you to know that I am here to help. I should rightfully start by informing you that seromas, and especially recurrent seromas after surgery can make the surgical site susceptible to infection and structural breakdown of the site. That being said, the symptoms of an infection are severe pain (something your doctor should be looking out for), fever, increased heart rate, etc. Either way, the best approach to treatment would be the surgical approach including excavation, debridement, drainage and adequate irrigation of the surgical site. Of course, other than infections we should also adequately rule out possible herniation due to the surgery conducted, but this can also be addressed if found during the surgical excavation. So it would be wise to go ahead with the surgical procedure at the earliest, as I understand how the pain you are experiencing can be excruciating and highly frustrating. I hope you find my response helpful. Please feel free to write back to me for any further clarifications, I would be more than happy to help you. Best wishes.