Failure to obtain microbiological culture and its consequence in a mesh-related infection

Abstract

This report describes a case of a delayed diagnosis of a late-onset mesh infection due to an unexpected enteric pathogen, Enterobacter cloacae. A 62-year-old woman with a history of prior incisional hernia repair with a prosthetic mesh presented to the emergency room with signs of an abscess with surrounding cellulitis of her abdomen over a year after her hernia repair. The patient manifested minimal response to 1 month of oral antibiotics. She underwent a complicated yet successful treatment course including surgical mesh removal (with a peri-operative complication), implantation of a biological mesh for the ventral hernia defect and ultimately, antibiotics tailored to the offending pathogen identified by postoperative culture of the infected mesh.

Figure 1

Abscess with surrounding cellulitis 1 day after percutaneous drainage. The blue arrow shows the orientation of the patient's upper torso and head.

Figure 2

Contrast-enhanced CT scan of the abdomen revealing phlegmon formation at the site of the abscess overlying the mesh, with evidence of mesh eventration.

Figure 3

Contrast-enhanced CT scan of the abdomen performed after a 1-month course of oral antibiotics revealing an abscess anterior to the prosthetic mesh.