Laparoscopic removal of mesh migrating into the sigmoid colon after totally extraperitoneal (TEP) laparoscopic inguinal hernia repair with positive faecal occult blood test

Abstract

A 76-year-old man was referred to our clinic after a foreign body seen in his sigmoid colon during a colonoscopy. He had undergone three operations for a left inguinal hernia within the previous 8 years, and the first procedure was a laparoscopic totally extraperitoneal approach. Four years later, removal of migrated and infected mesh was conducted by open approach. He then had a positive stool occult blood test for routine check-up 4 years after the remnant mesh removal. An ill-defined lesion was identified on colonoscopy. CT revealed a 2.7 cm diameter enhancing lesion in the sigmoid colon. Laparoscopic sigmoidectomy was performed, and remnant mesh fragment was found in the sigmoid colon and removed. The migrated mesh could not be wholly removed by open abdominal approach and the remnant mesh fragment migrated to sigmoid colon. It suggests the importance of a laparoscopic approach to remove the entire mesh.

Keywords: gastrointestinal surgery; general surgery.

Figure 1

An ill-defined ulceroinfiltrative mucosal change at 32–35 cm from the anal verge was found during colonoscopy. A foreign body (mesh) was clearly visualised.

Figure 2

Abdominopelvic CT images demonstrated a 2.7 cm diameter ill-defined enhancing soft tissue lesion at the sigmoid colon. (Arrows) a suspected radiopaque foreign body with adjacent peritoneal thickening and infiltration, probably reactive, was seen.

Figure 3

Subserosal foreign body (mesh) with granulomatous reaction around suture materials and focal transmural chronic active inflammation was found on histopathological examination: gross (resected sigmoid colon with mesh (to), and mesh fragment (bottom)) and microscopic (×20).