Mesh plug erosion into the small intestine after inguinal hernia repair: A case report

Abstract

Background: Mesh plug (MP) erosion into the intra-abdominal organs is a rare but serious long-term complication after inguinal hernia repair (IHR), and may lead to aggravation of symptoms if not treated promptly. It is difficult to diagnose MP erosion as there are no obvious specific clinical manifestations, and surgery is often needed for confirmation. In recent years, with the increased understanding of postoperative complications, MP eroding into the intra-abdominal organs has been a cause for concern among surgeons.

Case summary: A 50-year-old man was referred to the Department of General Surgery with the complaint of abdominal pain in the right lower quadrant for 2 d. He had a surgical history of right open IHR and partial thyroidectomy performed 20 years and 15 years ago, respectively. Computed tomography revealed a circinate high-density image with short segmental thickening of the ileum stuck to the abdominal wall, and no evidence of recurrent inguinal hernia. Laparoscopic abdominal exploration confirmed adhesion of the middle segmental portion of the ileal loop to the right inguinal abdominal wall; the rest of the small intestine was normal. Further exploration revealed migration of the polypropylene MP into the intraperitoneal cavity and formation of granulation tissue around the plug, which eroded the ileum. Partial resection of the ileum, including the MP and end-to-side anastomosis with an anastomat, was performed.

Conclusion: Surgeons should aim to improve their ability to predict patients at high risk for MP erosion after IHR.

Keywords: Case report; Complication; Erosion; Inguinal hernia repair; Mesh plug; Migration.

Figure 1

Ultrasonography identified a locally discontinuous band of strong echo in the abdominal wall of the right inguinal area. An inhomogeneous echo mass (dimensions: 3.9 cm ×1.5 cm) was detected on its deep surface.

Figure 2

Computed tomography revealed a circinate high-density image with short segmental thickening of the ileum stuck to the abdominal wall (orange arrow) with no evidence of recurrent inguinal hernia.

Figure 3

During surgery. A: Adhesion of the ileum loop to the right inguinal abdominal wall; B: Migration of the polypropylene mesh plug (MP) into the intra-peritoneal cavity; C: The internal ring was 1.0 cm in diameter, but no hernia sac was found; D: Specimen examination revealed erosion of the iliac wall due to the MP.

Figure 4

Postoperative pathology showed chronic inflammatory changes in the small intestine mucosa, with focal granulomatous tissue formation, and focal abscess in the serosa.