Post-operative umbilical cellulitis probably related to incidental colonic puncture by Veress needle entry during insufflation

OBJECTIVE: Laparoscopic surgery has become increasingly prevalent in modern gynecologic practice. However, this approach is not without risks. The most dangerous step is insufflation of the abdomen using a Veress needle or the blind creation of the camera port at the beginning of the surgery. Here, we report an interesting case of an umbilical camera port abscess, probably resulting from an incidental puncture of the colon by a Veress needle during initial insufflation. CASE REPORT: A 61-year-old Taiwanese postmenopausal woman underwent laparoscopic surgery for bilateral adnexal solid masses, incidentally discovered during regular follow-up for B-cell lymphoma. Insufflation and trocar placement were uneventful, but over-distended colon was observed without an identifiable cause. Bilateral broad ligament myomas, enlarged right ovarian solid mass, and an atrophic left ovary were noted. Only a right salpingo-oophorectomy was performed, and final pathology revealed a benign Brenner's tumor. Postoperative fever and leukocytosis occurred but subsided spontaneously. However, the patient later experienced spiking fever and a significant abscess at the umbilical trocar site. The abscess culture confirmed the presence of enteric bacteria. Her condition improved with broad-spectrum antibiotic therapy and wound care. CONCLUSION: An incidental puncture of colon by a Veress needle can lead to over-distension of the colon and bacterial contamination of the umbilical port tract. Greater postoperative vigilance and timely antibiotic coverage may help prevent this rare complication.