A Delayed Sterile Abscess Following a Percutaneous Coronary Intervention (PCI)-Related Myocardial Injury Successfully Treated With an Omental Flap: A Case Report

Topical hemostatic agents are commonly used in cardiac surgery to achieve rapid hemostasis in fragile myocardial tissue, particularly following myocardial infarction or mechanical injury during percutaneous coronary intervention (PCI). While effective in the acute setting, retained hemostatic materials can lead to delayed complications, including sterile abscess formation. We present a case of a 77-year-old man who developed a sterile abscess one year and nine months after emergency surgical hemostasis for myocardial oozing following PCI. The abscess presented as localized swelling and discharge from the lower end of the sternotomy scar. Laboratory tests showed no signs of systemic inflammation, and cultures were negative. Computed tomography (CT) revealed a fluid collection extending from the pericardial space to the subcutaneous tissue. Conservative treatment, including antibiotics and drainage, was ineffective. Surgical removal of the foreign material was performed under cardiopulmonary bypass. Due to dense adhesions and uncertainty regarding complete removal, a pedicled omental flap was transposed through the diaphragm into the pericardial space. Postoperative recovery was uneventful, and follow-up imaging confirmed complete resolution of the fluid collection. This case highlights the diagnostic challenge of sterile abscesses related to retained surgical materials and demonstrates the utility of omental transposition when complete removal is not feasible.