Mesh erosion into the colon following repair of parastomal hernia: A case report

Abstract

Background: In recent years, mesh has become a standard repair method for parastomal hernia surgery due to its low recurrence rate and low postoperative pain. However, using mesh to repair parastomal hernias also carries potential dangers. One of these dangers is mesh erosion, a rare but serious complication following hernia surgery, particularly parastomal hernia surgery, and has attracted the attention of surgeons in recent years.

Case summary: Herein, we report the case of a 67-year-old woman with mesh erosion after parastomal hernia surgery. The patient, who underwent parastomal hernia repair surgery 3 years prior, presented to the surgery clinic with a complaint of chronic abdominal pain upon resuming defecation through the anus. Three months later, a portion of the mesh was excreted from the patient's anus and was removed by a doctor. Imaging revealed that the patient's colon had formed a t-branch tube structure, which was formed by the mesh erosion. The surgery reconstructed the structure of the colon and eliminated potential bowel perforation.

Conclusion: Surgeons should consider mesh erosion since it has an insidious development and is difficult to diagnose at the early stage.

Keywords: Case report; Intestinal fistula; Intestinal internal fistula; Mesh erosion; Mesh migration; Parastomal hernia.

Figure 1

The computed tomography images and the mesh. A: The computed tomography (CT) images were taken in January 2021; B: The CT images were taken before hospitalization in April 2021. In A and B metal tackers were seen entering the intestine with the mesh located near the anus; C: After hospitalization, the mesh was partially excreted through the anus; D: The mesh was excreted intact along with its metal tackers.

Figure 2

The contrast agent was injected through the drainage tube placed through the stoma. The intestinal tube formed a t-branch tube structure.

Figure 3

Transanal colonoscopy revealed the stenosis. Metal tackers that have not yet been excreted can be seen.

Figure 4

The structure of the t-branch tube. A: The yellow arrow indicates the proximal colon, the white arrow indicates the colostomy colon, the purple arrow indicates the distal colon, and the blue circle indicates the small intestinal wall. Intraoperative exploration confirmed that the t-branch tube was composed of the distal colon, proximal colon, colostomy colon, and small intestinal wall; B: After separating the small intestinal wall, the structure of the t-branch tube could be more clearly identified; C: Surgical removal of the t-branch tube structure of the colon. The yellow marker shows the proximal colon, the green marker indicates the distal colon, the orange marker shows the original stoma, and the defect is the original small intestinal wall.