Delayed Recurrent Umbilical Drainage Due to Postoperative Cutaneous Overgrowth Following Panniculectomy: A Case Report

Persistent umbilical drainage is an uncommon clinical presentation with a broad differential diagnosis, including congenital anomalies, infection, retained foreign material, and postoperative sinus or fistulous disease.Delayed drainage following panniculectomy may present a diagnostic challenge, particularly in patients with extensive prior abdominal surgery.We present the case of a 43-year-old woman with a history of morbid obesity (previous body mass index greater than 40 kg/m²) and multiple abdominal operations who developed intermittent umbilical drainage several months after undergoing panniculectomy approximately six years before her most recent presentation.The drainage was scant to moderate, yellowish to clear, and associated with mild periumbilical erythema without tenderness.Computed tomography demonstrated localized subcutaneous soft-tissue thickening extending toward the anterior abdominal wall fascia without an identifiable fluid collection, hernia, or intra-abdominal communication.Approximately 16 months before her most recent presentation, surgical exploration identified retained Ethibond suture material, believed to originate from the panniculectomy, which was removed.Despite initial improvement following suture removal and a seven-day course of oral trimethoprim-sulfamethoxazole, drainage subsequently recurred.Definitive surgical exploration revealed a superficial cutaneous pocket formed by overgrowth of the surrounding umbilical skin, without an identifiable deeper sinus tract.Excision of the abnormal tissue and umbilical reconstruction with fascial anchoring resulted in immediate resolution of drainage.Following three months of postoperative surgical follow-up and continued bariatric care, the patient remained free of recurrent drainage at approximately one year after reconstruction.This case illustrates how postoperative cutaneous overgrowth may create an acquired superficial umbilical pocket, descriptively termed a pseudosinus, that clinically mimics a sinus tract without a demonstrable deeper communication.Although retained suture material may have contributed to localized inflammation, persistent anatomical distortion may also have played a role in recurrent drainage.Recognition of postoperative umbilical anatomical abnormalities is important when evaluating delayed recurrent drainage following panniculectomy, as surgical correction may provide sustained symptom resolution when retained foreign material has been removed, but symptoms recur.