A Chronic Recurrent Discharging Sinus Tract Following Cesarean Section: A Case Report of an Uncommon Complication of a Common Surgery

Background: The formation of a sinus tract is an uncommon complication of abdominal surgeries, where deeper tissues are connected to the skin. The pathophysiology can range from infection, mainly tubercular, to liquefaction of adipose tissue, and rarely retention of foreign bodies. Recurrent discharging sinuses may culminate from misdiagnosis and inadequate surgical drainage. We present an unusual case of recurrent discharging sinus post-cesarean, unraveling a suture granulomatous inflammation. Case report: A 31-year-old woman with a history of previous 2 cesarean sections presented with a chronic on-and-off pus discharge from the transverse scar. She received multiple courses of antibiotics previously. Pus culture for microbiological analysis was found to be negative for organisms, including Mycobacteria species. Magnetic Resonance Imaging with contrast revealed a likely vascular/ inflammatory collection along the rectus sheath, indicating a utero-vesico-cutaneous sinus tract. A methylene blue-stained tract facilitated its complete removal. A final histopathological staining concluded the possibility of a suture granuloma. Discussion: Tuberculosis is known to present with similar symptoms, especially years after abdominal surgery, and needs a thorough preoperative exclusion. In our case, the presence of a nontubercular granulomatous inflammation with a suture seen along the tract confirmed the diagnosis. The patient did not report any recurrence of symptoms during the six-month follow-up. Conclusion: Imaging the entire tract and performing complete excision, followed by judicious use of subcutaneous drains and closure with delayed absorbable monofilament sutures, are preferable to avoid recurrence. This case emphasizes the importance of timely diagnosis in improving the quality of life of the affected patients.