Lesser Sac Haematoma-Melioidosis - A Surgical Surprise

Author(s): Anuraj Appukuttan1, Abhijith Valsalan2, Sherin Shaji3, Gowri Gopal4

Melioidosis, a potentially fatal disease endemic in South East Asia and Northern
Australia is caused by Burkholderia pseudomallei, a potential bioterror agent. It is
a motile, aerobic non-spore forming gram negative bacillus often characterised by
pneumonia and multiple abscesses, but it can also present as septic arthritis,
cutaneous ulcer and osteomyelitis. Modes of acquisition are inhalation, inoculation
and rarely ingestion from a contaminated environment.1 General and gastro
surgeons rarely come across abdominal melioidosis and rare is a lesser sac
haematoma secondary to mycotic aneurysm of splenic artery caused by
Clinical manifestations can vary from asymptomatic infections to localised
abscesses to fulminating diseases with multiorgan involvement and eventual
death. Due to evolving lifestyle, extensive travel and climate changes the disease
which was previously confined to specific countries has crossed its boundaries.
Increase in cases of comorbid conditions like diabetes and immunocompromised
states have added on to the cause of increasing rates of the disease worldwide.
India has seen isolated case reports from few states. Most often Burkholderia
pseudomallei is misreported as pseudomonas species especially in resource-poor
laboratories making the disease potentially fatal due to error in the treatment
protocol.2 Due to its high chance of recurrence, prolonged treatment with
combinations of antibiotics is required for complete eradication.