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Why Shall I Do About A Hematoma That Hasn't Gone Away Even After A Month Post Having An Open Inguinal Hernia Surgery?

Posted on Thu, 5 Oct 2023

Question: I had open inguinal hernia surgery on a large left side hernia 9 weeks ago. A few days after I developed a large hematoma at the surgery site. Had a ulta sound at local er. The hernia surgery was done at a very large university hospital about a hour plus from my home. I saw a urologist and the surgeon 4 weeks post surgery. Both said it would take 2 months to go away.. The surgeon said to come back in 4 weeks which is later this week I have a call into the university surgeon. At this time it inle reduced about 50% measuring myself with a ruler. originall the hematoma was 10x 5 cm. I am a type two diabetic under control.also high blood pressure under control. I am getting very concerned. Any advice

Answered by Dr. Bhagyesh V. Patel (1 hour later)

Brief Answer:
Hematoma is likely consequence of large hernia repair.

Detailed Answer:

Hello,

I have read your query thoroughly.

* Hematoma formation is likely consequence of large hernia surgeries with mesh
repair.
* As there is diabetic stage, precise care is vital part for its recovery and
avoidance of secondary infection.

Kindly provide me further details so that I can answer your query completely.

1. Are you having pain, fever at present or not.
2. Bowel movements are okay or disturbed.
3. Details of current medicines consumed for hematoma.
4. If possible and no objection, kindly provide a photo picture of the hematoma as
an attachment in follow up conversation.

Awaiting for your response.
Wish you fine recovery.

Regards.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Bhagyesh V. Patel (50 minutes later)

Dr. I have been experiencing minor discomfort 2/10 the lasr few day. I see the surgeon this week. I am not on any meds for hematoma . no fever . Gi system is a little better than before surgery. take lots of magnesium and Linzess. I HAVE BEEN DEALING WITH CONSTIPATION FOR ALMOST 30 YEARS. DR. is advising on meds and supplements. All my colonoscopy have been clean and I am due again in oct 2020, but I paid for epi procon blood test which came back positive and a virtual colonoscopy which showed many small polys which the Radiologist said are not of concern and one questionable body in the Cecum which could be a polyp or stool. Scheduled for another colonoscopy or virtual colonoscopy or petscan in a few months. Radiologist does not thin a GI doc can get to the Cecum. Any thoughts on this. I hope the hematoma does delay a colonoscopy is its possible to get to the Cecum. The hematoma is about half the original diameter means 2.5 cm now in diameter of a tube like hematoma . adjacent to my penis. Not sure how long it is. Originally ulta-sound showed it 10 cm in length. As I sit here writing this , I definitely feel pain [again 2/10). This discomfort started last week... I have numbness and pain on outside of my left thigh. Inguinal Hernia was on left side. I hope this provides some information of value. Maybe its just taking longer than two months. XXXXXXX

Answered by Dr. Bhagyesh V. Patel (9 minutes later)

Brief Answer:
follow up .

Detailed Answer:
Hi
Thanks for the details.

* As the size of hematoma is reducing, it is not of much worry.
* For caecum approach, primary concern is to clear the bowel precisely with bulk
forming laxative on regular basis before check up possibility.

* Present guidelines for hematoma

- Ice application 5 minutes each 3 times a day.
- Keep the part clean with antiseptic liquid.
- Avoid direct compression with tight clothing.

- Analgesic intake in case of more pain beyond 3 of 10.
- Keep chart of size on day to day basis.
- Maintain blood sugar levels under control.

* Usually it takes around total period of 4-6 weeks depending upon the intensity
of the condition for complete resolution of hematoma.

Welcome for further doubts.
Take care.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhagyesh V. Patel (37 hours later)

I am scheduled to see the surgeon thursday[2 days from now]. I do not believe the hematoma is reducing in size. I may be having an ultrasound before I see the Surgeon. My question is what options are open to the Surgeon. I understand a drain is one option, what are the other options. The Surgeon is associated with a major university hospital, but it is 90 minutes away and I do not always someone to drive me to the university hospital. XXXXXXX

Answered by Dr. Bhagyesh V. Patel (7 minutes later)

Brief Answer:
follow up .

Detailed Answer:
Hello XXXXXXX

* Apart from incision and drainage, the surgeon has following options

1. Aspiration of hematoma with wide bore needle ( usually not recommended
keeping in concern of secondary infection )
2. Broad spectrum antibiotics to resolve it faster.

Hope this will help you to understand the sequence.
Regards.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bhagyesh V. Patel (38 minutes later)

can I ask what is incision and drainage. Is it an outpatient procedure where that put in a drain and I come back another time when the hematoma is gone. OR, is the whole procedure done at one session and I go home without a hematoma?? ALSO,
will this be done under local anethesia?? XXXXXXX

Answered by Dr. Bhagyesh V. Patel (7 hours later)

Brief Answer:
follow up .

Detailed Answer:
Hello XXXXXXX

* Incision and drainage is minor surgery in which an incision is kept over the
center of the hematoma, internal contents are drained, sterile dressing applied
with or without drain depending upon the surgeon`s decision per operative.

* The type of anesthesia can be local or general as per the severity of the
condition.

* In either of the anesthesia, you can walk home in few hours as it is a day care
procedure ( does not require over night hospital stay ).

If I had a photo snap of the hematoma, I would have been in a much better position to guide regarding this.

Thank you.

Note: For further inquiries on surgery procedure and its risks or complications book an appointment now

Above answer was peer-reviewed by : Dr. Yogesh D