Laparoscopic Management of a Large Seminal Vesicle Abscess Arising from an Infected Epidermoid Cyst After Failed Conservative and Image-Guided Treatment: A Case Report

Background and Clinical Significance: Seminal vesicle abscess (SVA) is a rare genitourinary condition with a nonspecific presentation that may delay diagnosis. Treatment includes antimicrobial therapy and, when necessary, drainage. Managing large collections that cannot be evacuated by image-guided aspiration remains challenging. This case illustrates an infected epidermoid cyst in a patient with a congenital solitary kidney, managed by laparoscopy after unsuccessful conservative and image-guided treatment; Case Presentation: A 76-year-old man presented with fever and perineal pain. Transrectal ultrasonography (TRUS) and computed tomography revealed an SVA measuring 115.8 × 83.1 × 72.4 mm. Initial conservative treatment produced only partial improvement, and symptoms recurred four weeks later. TRUS-guided drainage was attempted but failed because of the dense, highly viscous contents. Transperitoneal laparoscopic drainage and unroofing were subsequently performed. The abscess was separated from the surrounding structures, drained by aspiration, and partially excised. Two drains were placed. The operative time was 110 min, with no intraoperative complications. Recovery was uneventful, and the patient was discharged on postoperative day 4. Histopathological examination of the excised wall demonstrated an epidermoid cyst with secondary infection, suggesting that the abscess developed within an underlying epidermoid cyst. No recurrence was observed over two years of ultrasound follow-up and on a control CT at two years; Conclusions: Laparoscopic drainage and unroofing may be considered for selected large SVAs when conservative treatment and image-guided drainage are unsuccessful. Direct visualization facilitates access to the deep pelvic collection. This single case supports procedural feasibility but does not establish superiority over other drainage approaches.