Mesh erosion to urinary bladder causing fistulation to abdominal wall resulting in necrotizing fasciitis: A case report of late complication of incisional hernia

Abstract

Introduction: Incisional hernia is not an uncommon complication after abdominal operation, and laparoscopic ventral hernia repair with mesh is commonly performed nowadays. It is thought to have less complication compare to the traditional open repair, yet late complication is still observed occasionally and can be disastrous.

Case report: We hereby report a case of abdominal wall necrotizing fasciitis 21 months after laparoscopic incisional hernia repair in lower midline with dual mesh, due to mesh migration and erosion into urinary bladder, resulting in fistulation between bladder and abdominal wall. Repeated debridement and removal of mesh was required for sepsis control and the patient required intensive care support due to multi-organ failure. Subsequent repair of urinary bladder and abdominoplasty was performed after condition stabilized.

Conclusion: This case was the first reported incident with bladder erosion by dual mesh causing vesico-cutaneous fistula complicated with necrotizing fasciitis. Although dual mesh theoretically reduces the risk of mesh erosion, mesh erosion to viscera can still happen and cause severe complication. Its risk should be balanced and discussed with patient with full consent.

Keywords: Composite mesh; Incisional hernia mesh repair; Mesh migration; Necrotizing fasciitis; Urinary bladder fistula.

Fig. 1

CT scan showing a 8 × 3 × 4 cm rim-enhancing collection in the subcutaneous region of lower abdomen. Small calcification noted in the anterior bladder wall and in the collection suspicious of foreign body.

Fig. 2

Photo showing the wound after the first debridement.

Fig. 3

Removal of mesh and repair of urinary bladder was performed.

Fig. 4

Abdminoplasty was performed 4 weeks after first debridement.