PARAVESICAL SUTURE ABSCESS DIAGNOSED 4 YEARS AFTER TRANSVAGINAL UTERECTOMY

A 47-year-old woman with previous history of transvaginal uterectomy 4 years before, presented to another hospital complaining of pollakisuria and pain during micturition. She was treated with antibiotics, but symptoms failed to resolve. So she referred to our department for investigations and treatments. On cystoscopy, there was a large mass with edematous mucosa in the anterior wall of bladder. Magnetic resonance image demonstrated an 8 cm irregularly-formed cystic mass which occupied dome of bladder. Resection of the mass including partial cystectomy was performed. This cystic mass contained retained 3 silk sutures surrounded by green color pus. Microscopic examination revealed inflammatory granulations without any malignancy. Because of the previous history, she was diagnosed as paravesical suture abscess due to infected silk materials at transvaginal uterectomy. Paravesical suture abscess is very rare complication of inguinal herniorrhaphy and mimics bladder or urachal neoplasm. In review of previously reported cases, the symotoms were predominantly urological. For avoiding unnecessary examinations and treatments, it is important to consider paravesical suture abscess in cases with histories of inguinal herniorrhaphy or other intra-pelvic operations. To our knowledge, there is no case report of paravesical abscess formation associated with transvaginal uterectomy and the present case is the first one for report.