A Diagnostic and Therapeutic Approach to Retained Anchoring Sutures: Color Doppler Ultrasound for Diagnosing and the Retract-and-Cut Technique for Minimizing Invasive Interventions

Abstract

Background: Retained sutures following catheterization procedures are rare but can present significant diagnostic and therapeutic challenges. This case highlights a novel approach to diagnosing and managing a retained anchoring suture following catheter removal for abdominal fluid drainage in a patient with pancreatic adenocarcinoma and metastatic ascites. The use of color Doppler ultrasound to identify the suture's path and the application of the retract-and-cut technique minimized invasive interventions, demonstrating a safe and effective alternative to surgical removal.Case Presentation: A 68-year-old male with pancreatic adenocarcinoma and metastatic ascites underwent subhepatic fluid drainage using an 8Fr pigtail catheter. After successful drainage and catheter removal, the patient presented with localized pain and tenderness at the catheter insertion site. Ultrasound revealed a hyperechoic linear structure in the subcutaneous tissue suggestive of a retained suture. Real-time visualization using color Doppler ultrasound confirmed the suture's path as a linear Doppler signal was observed during manipulation. Given the adhesion of the suture to deeper tissues, the retract-and-cut technique was employed. The suture was gently pulled taut at the skin surface, cut, and allowed to retract along its original track, avoiding unnecessary trauma. The patient experienced no recurrence of symptoms, fluid collection, or infection during long-term follow-up.Conclusions: This case underscores the importance of timely diagnosis using color Doppler ultrasound, which provided real-time visualization of the retained suture and its relationship with surrounding tissues. In addition, the retract-and-cut technique offers a minimally invasive and effective approach for managing retained sutures, avoiding the need for surgical intervention. This method ensures patient comfort and safety, particularly in palliative care settings where nonsurgical options are prioritized.