Mesh migration into the sigmoid colon after inguinal hernia repair presenting as a colonic polyp: A case report and review of literature

Abstract

Mesh migration and penetration into abdominal viscera rarely occur after laparoscopic inguinal hernia repair. We present the first case of mesh migration into the sigmoid colon identified as a colonic polyp at initial colonoscopic examination. The patient complained of mild abdominal distention in the lower abdomen over the previous year without changes in bowel habits or stool appearance and without weight loss. By complementary endoscopic ultrasonography, a cavity-like structure beneath the suspected polyp was further confirmed. Enhanced abdominal computed tomography merely revealed local bowel wall thickening and inflammation of the colosigmoid junction. The migrating mesh, which was lodged in the sigmoid colon and caused intra-abdominal adhesion in the lower abdominal cavity, was finally identified via exploratory surgery. The components of inflammatory granulation tissue around the mesh material were diagnosed based on histological examination of the surgical specimen after sigmoidectomy. In this patient, nonspecific endoscopic and imaging outcomes during clinical work-up led to the diagnostic dilemma of mesh migration. Therefore, the clinical, radiological and endoscopic challenges specific to this case as well as the underlying reasons for mesh migration are discussed in detail.

Keywords: Colonic polyps; Colonoscopy; Computed tomography; Foreign bodies; Hernia repair; Sigmoid colon; Surgical mesh.

Figure 1

Abdominal computed tomography findings. Abdominal computed tomography showed bowel wall thickening and inflammatory stranding involving the colosigmoid junction (white arrow).

Figure 2

Endoscopic findings. A: Colonoscopy revealed a polypoid lesion in the sigmoid colon, which was hyperemic and oozed a pus-like substance; B: Endoscopic ultrasonography showed a mucosal lesion (1.23 cm × 0.62 cm) with a cavity-like structure below in sectional dimension.

Figure 3

Intraoperative findings. A: Mesh (arrow) penetrated the sigmoid colon and was intimately involved in the bowel wall; B: The “polyp” (slanted arrow) was observed on the luminal side of the bowel wall.

Figure 4

Histological findings revealed by Hematoxylin and Eosin staining of paraffin-embedded sections from the surgical specimen. A: The presence of a foreign body in the bowel wall, which caused inflammatory infiltrate and granulation tissue formation in the surrounding tissue (magnification × 10); B: Infiltration of massive inflammatory cells and formation of granulation tissue (magnification × 100); C: Foreign-body giant cells were observed (magnification × 200); D: Prosthetic mesh material (magnification × 100).