Poster Presentation Australian and New Zealand Obesity Society Annual Scientific Conference 2023

Panniculus morbidus – a rare end-stage complication of severe obesity and increasing surgical problem (#200)

Tessa Daly 1 , Nelson Chen 1 , Wei Ming Ooi 1
  1. Northern Hospital, Epping, VIC, Australia

Introduction

Obesity is a growing epidemic globally. Panniculus morbidus is a distinct clinical and pathological entity described by Farshid and Weiss characterised by a large overhanging abdominal pannus complicated by lymphoedema. It can cause serious complications including life-threatening sepsis. It also affects personal hygiene, mobility and function with significant impact on quality of life (QOL) and psychosocial wellbeing. We report a case of recurrent sepsis from a large abdominal panniculus managed successfully by panniculectomy.

 

Case

A 29-year-old female with BMI 95 kg/m2 and no medical history presented with sepsis associated with a  White Cell Count 20.3 x 109/L and C-Reactive Protein 412mg/L. She had an abdominal pannus extending to her knees with a seven centimetre area of ulceration. The pannus was indurated with extensive fibrotic skin changes which significantly affected her QOL requiring assistance for all activities of daily living (ADLs). She initially responded to antibiotics but had recurrent admissions with worsening infection and lymphoedema which necessitated a panniculectomy.

 

Operative preparation involved stretching the pannus inferiorly and superiorly to mark the limits of resection to ensure adequate skin flaps for closure without undermining nor tension. The incision was adjusted away from the mon pubis achieve adequate seal for a Prevena negative pressure dressing. The patient was discharged post-operatively day 2 with drains managed by community nurses.

 

She was discharged from clinic two months post-operatively and has not been re-admitted for over six months. The patient’s QOL has significantly improved, now able to mobilise and perform ADLs independently. She receives ongoing care in a lymphoedema clinic and has been referred for bariatric surgery to assist further weight loss.

 

Conclusion 

Abdominal panniculectomy is an effective treatment to alleviate acute morbidity in severe obesity and should be considered early as an option in patients with recurrent life-threatening infections and significant impact on QOL.

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