Ultrasound-Guided and Laparoscopic Instrument-Assisted Drainage of Retropubic Hematoma Secondary to Laparoscopic Burch Colposuspension

A 37-year-old, gravida 3, para 3 woman presented with intermittent fever, chills, and vague lower abdominal pain for 2 days. Ten days previously, she had undergone a transperitoneal laparoscopic Burch colposuspension for stress urinary incontinence. Physical examination and ultrasonography showed a tender mass, about 7 x 6 cm in size, occupying the retropubic space. Her hematogram disclosed a hemoglobin of 9 g/dL and a white cell count of 18,000/μL with 80% neutrophils. Analgesics and parenteral broad-spectrum antimicrobial agents were given after admission, but were in vain. We proceeded to drain the infected hematoma by using a high-flow suction-irrigation probe through a 5-mm trocar under ultrasound guidance. With strong hydraulic pressure, the probe enabled aquadissection with disruption and complete evacuation of blood clots. The woman experienced a prompt recovery from the complication.