A case of intractable subareolar abscess that was cured by excision of fistula with a thread guide

Abstract

The patient was a 25-year-old unmarried woman. She had noticed a lump in a medial region of the left areola in December 2004, which spontaneously disappeared. However, the lesion relapsed during menstrual period. Although a family physician advised her conservative observation, she visited our clinic for further examinations in February 2005. Not only physical examination but also ultrasonography suggested that the mass under the left areola was likely to be an abscess. A needle aspiration failed to obtain pus, but cytology of the smear was negative for malignant cells. There was not nipple retraction but a slight inflammatory sign such as redness alone. Thus surgical excision or drainage was reserved. She revisited us in early March, when inflammatory process was exacerbated with menstruation. Ultrasonography revealed an enlarged abscess collection. Then incision and drainage were performed. Thereafter she had recurrence of subareolar abscess repeatedly. In July pus drainage from the nipple due to compression was noted. A 3-0 nylon thread was inserted through a fistula and drawn out from the nipple. The thread was ligated there in a loop and left in place. The operation was performed in September under general anesthesia. The fistula was removed as far as possible using the strand of nylon thread as guide, and affected lactiferous duct in the nipple was open and curetted. No relapse has been observed in 3 months after operation.