Panniculus morbidus: obesity-related abdominal wall lymphoedema

Abstract

A 52-year-old female patient presented with a massive abdominal wall swelling that adversely affected her lifestyle. Imaging revealed significant subcutaneous oedema and the presence of grossly distended veins. Subsequently, she underwent a 'toilet' panniculectomy and abdominoplasty. We describe the surgical technique used to retract the lymphoedematous tissue facilitating excisional surgery, and discuss the pathophysiology of this condition and the possible contribution of venous obstruction to the development of subcutaneous oedema.

Keywords: General surgery; Obesity (nutrition); Obesity (public health); Plastic and reconstructive surgery.

Figure 1

Panniculus morbidus extending below the level of the knees. The postoperative result of the abdominoplasty demonstrated a significant reduction in the abdominal wall mass and therefore allowed an improvement in the patient’s mobility and quality of life. Left = preoperatively; right = postoperatively.

Figure 2

(A) Coronal and (B) sagittal CT images of the abdomen and pelvis revealed significant oedema and the presence of grossly distended veins, measuring up to 13 mm in diameter.

Figure 3

(A) During panniculectomy, 10 Lane’s tissue holding forceps were used to connect the abdominal wall to a metal bar fixed to the patient hoist to facilitate removal of the lymphoedematous tissue. (B) The resected mass elevated from the abdominal wall weighing 35 kg.