Fluid is leaking from the incision made for hernia surgery. What to do?

Hi doctor,

My sister underwent hernia surgery in her right lower abdomen four months back. As she was having slight pain and fever at that time, the doctor suspected some infection there. When the surgery was done, her infection was mild but they did not place a mesh there. Her surgery went fine. After a week or two, we saw a small hole in her incision. She started to have some fluid leaking from it. We consulted the doctor again. He asked us to monitor it for some months. It has been a month now. The incision has some fluid leaking from it but she does not have pain or fever or anything. She has some clear fluid that seems to be thick and odorless. We can see some progress and it has reduced a little bit. What is the reason for having it? She is completely fine. But she has some fluid coming out of her incision. We went to another doctor and he suggested having surgery saying that it can be an intestinal fistula. Kindly help us.

Thank you doctor,

The doctor has asked her to wait for six weeks again. She usually has a small to medium-sized patch on her gauge. She is eating a lot of junk foods but her bowel is completely fine. She does not have a fever. The liquid remains a little bit yellowish or sometimes transparent. But it does not look like pus as it is odorless and she does not have any pain in her incision. During her surgery, she was not placed with a mesh due to the cavity present in her. We suspect it as the same cavity or something in the abdominal wall. We are worried as it can be an intestinal fistula. We are just applying betadine daily.

Thank you doctor,

We hope that she may not require surgery and it will get healed on its own. She avoids taking bath because once when she did it, she had a lot of liquid coming out from it. Can she clean the hole with a warm towel?

Thank you doctor,

We can see the liquid turning thick and brown for the past two days. But she does not have any pain or uneasiness. Is it due to Betadine? Because the original color of the liquid remains yellow and sometimes, thick.

Thank you doctor,

It is almost a month after waiting for the liquid to subside. She has done her CT scan. The doctor told that there is a connection with her intestine. The amount of fluid coming from it has reduced. She has a single drop or even less and it is not thick. It seems to be yellow in a very small amount. We did a culture test and it shows nothing abnormal. There is an absence of bacteria. She is completely fine and her bowel is also fine. She does not have any fever, pain, or anything. When the doctor was doing a CT, some amount of dye went to a little near the intestine. He suggested that she needs surgery requiring removal of intestine. Again, he asked us to wait for two months saying that it can get filled up on its own sometimes. In some cases, surgery is required. What is your suggestion? Does it look like something related to the intestine? Kindly suggest.

Thank you doctor,

I forgot to mention that the doctor told me that the size of the cavity remains around 0.3 to 1.59 inch. Does cutting off intestine is required to remove a small fistula? We do not know whether it penetrates the intestine or just touching it.

Thank you doctor,

I am attaching her CT reports. Kindly go through it and give your opinion.

Thank you doctor,

Kindly go through her attached images and CT.

Thank you doctor,

I am attaching her previous CT reports. After doing surgery, my sister has some fluid coming out for a month. It got reduced with time. But now, it has started to come again in more amount. We are going back and forth. But it has got increased slightly from last week. Kindly tell us a solution. Can it be resolved without surgery?

Thank you doctor,

She was getting only a few drops for the past two to three days. But from the last night, liquid remains thick and a half tablespoon of thick liquid came out today morning and again after two to three hours. Is there anything to be worried? I am attaching a picture.

Thank you doctor,

Her discharge was pretty less for the past few days. Yesterday, her wound became closed from the top. But still, he has some fluid coming from inside and we can see a small bulge over the cavity. We pierced it with a sterile syringe and fluid came out. Yesterday night, she had more fluid than usual. I am attaching a picture. My sister told me that she feels to have some gas coming out of the wound once. Can we pierce it?

Thank you doctor for the reply,

I hope you remember our case. I had taken a few online consultations from you last year. We postponed the surgery for nearly one year, although the liquid never stopped coming, its intensity drastically reduced. We could not wait any longer and had to get it corrected. Last week, she had a CT (computed tomography) scan, and the results were nearly the same. The CT scan confirmed that it requires the same surgery as last year, and she will be undergoing the surgery tomorrow. My parents, who are non-doctors, started reading the CT report on their own with no knowledge and are now getting tense. I am attaching the CT report. We are aware that there is a connection with the small intestine, and a part of it will be removed. Can you please provide some information about it?

Thank you doctor for the reply,

Looking at the CT report, I hope there is not anything serious apart from this. Could you please provide us with information about that? Thank you for your valuable time.

Thank you doctor for the reply,

Hope you are doing well. I have talked to you regarding my sister many times. After a hernia surgery last year, she developed a small fistula in her intestine and had to undergo another surgery. Thankfully, everything went smoothly by God's grace. It has been five months, and she is doing absolutely fine. However, recently she has been experiencing slight tenderness under her laparotomy incision. A small portion under the incision feels a bit hard. She also checked her temperature, and it is currently 99.2°F. She has developed a fear of hernia recurrence. We asked her to bend forward and backward, and she could do so easily without experiencing any pain. We also applied pressure to the area, but the pain was minimal (although there is some sensitivity and slight pain).

It is affecting her mental health once again. She fears that she has developed another hernia. What could be the cause of her symptoms? Our primary doctor is currently unavailable, and we need to consult another doctor who is familiar with her medical history. Can you please explain the actual symptoms of a hernia and what could be causing the tenderness she is experiencing under her incision?

Thank you doctor for the reply,

To be precise, she does not feel any pain while walking or standing. It's just some tenderness in two to three stitches in the lower abdomen of her vertical laparotomy incision (slightly below the panty line). She has also tried coughing or bending down without experiencing pain. She feels hardness, redness, and slight tenderness. Additionally, she developed a low-grade fever today. I would like to know more about that. If it is not a hernia, what else could be causing these symptoms?

Thank you!

Thank you doctor for the reply,

We visited a local gynecologist as our surgeon is currently unavailable. The gynecologist conducted a thorough examination of my sister's scars and determined that it is keloid formation. She prescribed antibiotics. Although the swelling has reduced, there is still redness around the area and my sister experiences a fever (ranging from 99.5-100°F) in the evening. We are becoming extremely anxious due to her evening fever. The scar is slightly swollen and red. Could you please provide some insights into the possible cause?

Thank you.

Thank you doctor for the reply,

After taking the prescribed medicines (tablet Ornof twice a day and tablet Chymoral Forte), the hardness and tenderness have reduced, and the pain in the three stitches has also lessened. However, redness still persists. The area beneath the stitches has become soft, and she no longer experiences any pain or tenderness even when pressure is applied. Our concern now lies with her fever, as she also has a cough. Could it be related, or could it possibly be a viral fever?

Thank you.

Thank you doctor for the reply,

What could be the reason for the redness, along with hardness in that specific area?

Thank you doctor for the reply,

I consulted with you two days ago. There has been an improvement in the redness around the scar, and my sister is currently experiencing no pain. However, we have noticed that her stitch is turning white, and we can see some pus inside it, as if it may come out at any time. The only issue we are facing is that she has a fever (ranging from 100-100.5°F) along with cough. We are unable to determine whether it is due to a viral infection or if it is related to the stitch becoming infected. Additionally, what should we do about the stitch? We can clearly see that it is becoming soft and contains pus, but how will it come out?

Thank you doctor for the reply,

I am attaching a picture (attachments removed to protect patient's identity) of the scar. Please help us understand what it could be. It is causing us a lot of anxiety. Could you please provide detailed information on the possible causes?

Thank you doctor for the reply,

If possible, may I please have a conversation with you over a call or video? I would be incredibly grateful, and I am willing to pay more for this service. My parents and sister's mental health is deteriorating, and I strongly desire them to have a personal conversation. If it is feasible, could you kindly talk to them directly at this moment?

Thank you doctor for the reply,

Thank you doctor for the reply,

One last thing I would like to ask is how to determine if it is actually a hernia. Is it possible for a hernia to be painless? Could you please provide us with some distinguishing points that can help differentiate between a hernia and a superficial stitch infection?

Thank you doctor for the reply,

We visited our surgeon two weeks ago when my sister developed a small bulge on her scar. A local gynecologist suggested it could be a hernia. However, the surgeon responded positively and diagnosed it as a normal infection. He made an incision in the bulge to release the pus, as you previously mentioned. A culture test was conducted, revealing an E. coli bacterial infection.

Now, the concern is that the incision made by our surgeon to drain the pus has healed, and we notice some redness on the skin. However, when my sister urinates, a few drops of white and slightly red liquid come out. She stopped taking the Ofloxyn medicine one week ago. We are curious about the reason behind this liquid discharge in the past three to four days. What could be the possible cause? I have also attached pictures (attachments removed to protect patient's identity) of the scar before and after the incision.

Than you.

Thank you doctor for the reply,

Actually, my sister asked the surgeon if she should open the wound to let the pus drain, and the surgeon advised against doing so since the wound will heal on its own. The surgeon mentioned that there does not seem to be any connection from the bottom, which I believe is not the case. This is causing a bit of worry. I am also attaching (attachments removed to protect patient's identity) a picture of the wound. The liquid that is coming out is from the central part, while the rest of the yellow part is Betadine antiseptic solution.

Thank you doctor for the reply,

There is just one more thing I want to ask. My sister mentioned that the liquid comes out as soon as she urinates, but it is only a single drop. Otherwise, it does not come out. This has been happening for the past three to five days, and it is what concerns my parents a bit. You are aware of her medical history, and she experienced something similar before undergoing her surgery. Could you please provide us with some information regarding this?

Thank you doctor for the reply,

Thank you doctor for the reply,

Thank you doctor for the reply,

You have been patient with us throughout this period. As a doctor, it must be challenging to answer queries regarding the same problem, yet you have shown tremendous empathy, for which I cannot thank you enough. My sister, who has undergone these surgeries multiple times, has developed anxiety related to them, which affects us as well. We apologize for any inconvenience caused. We will ensure that she visits a counselor.

Thank you.

Thank you doctor for the reply,

I previously spoke to you regarding my sister who underwent a laparotomy for her fistula and later developed a sinus after the surgery. You mentioned that it is more of a cosmetic issue and advised us to wait. We waited for almost two months, but our doctor recommended a CT scan to determine the source of the connection. The CT reports revealed a 1.96 inch sinus in her lower abdomen (pelvic area). The amount of liquid has reduced to a maximum of one to two drops per day, compared to the previous ten to fourteen drops. Our doctor has advised us to continue waiting to see if it can close on its own. He suggested considering corrective surgery only if it becomes bothersome for my sister in the future.

I would like to know your opinion on this matter. Should we continue to wait or opt for surgery? Are there any chances of it healing on its own? I have attached the CT reports for your reference.

Thank you.