Omental flap coverage to treat symptomatic perigraft hygroma recurrence after aortic aneurysm repair

Perigraft hygroma (PGH) is a sterile fluid collection that forms around an aortic graft following aneurysm repair; it occurs in up to 18% of cases. Despite its relatively high incidence, optimal management of PGH is not clearly defined. We present a case of a 65-year-old male with an extensive aortic surgical history who developed a large, symptomatic PGH. The patient underwent open evacuation and pedicled omental flap coverage in an effort to treat symptoms while avoiding the morbidity of graft excision. His symptoms resolved postoperatively. However, imaging at 2 months showed recurrence of the PGH, although reduced in size compared with preoperatively. This case suggests that drainage and omental flap coverage may be useful in treating PGH symptoms but does not prevent recurrence.