Colocutaneous Fistula Formation Following Inguinal Hernia Repair: A Case Series

Abstract

Mesh placement remains the standard of care for inguinal hernioplasty, whether through the classic open approach or the transabdominal preperitoneal (TAPP) approach. Though both techniques are generally safe, they can occasionally result in visceral injuries, albeit infrequently. Mesh migration into the intestines is a morbid situation requiring emergency treatment. We present two male patients who developed mesh-enterocutaneous fistula several years after inguinal hernia repair. The first patient with a history of a bilateral TAPP hernia repair was admitted to the emergency department and underwent bilateral complete mesh removal, limited right colectomy, and wedge resection of the sigmoid colon, due to mesh erosion. The second patient, with a history of a left inguinal hernia treated by open mesh repair, presented to the emergency department complaining of intense pain in his left inguinal area. Erosion of the prosthetic mesh into the sigmoid and a colo-cutaneous fistula was identified, with sigmoidectomy and en bloc excision of the adherent mesh and end-colostomy being performed. Mesh erosion into the intestinal tract is a rare but serious condition. In patients presenting with a subcutaneous abscess in the inguinal region, clinicians should maintain a high level of suspicion for intrabdominal inflammation arising from mesh erosion into adjacent viscera. Surgical management becomes necessary in symptomatic cases or instances of fistulization.

Keywords: emergency surgery; enterocutaneous fistula; hernia; hernia mesh; laparoscopic tapp repair.

Figure 1. (A) Mesh fixating material into an abdominal wall fluid collection with air bubbles (white arrow). (B) Intraoperative photograph indicating intestinal erosion due to mesh migration and a fistulous tract on the left lower portion of the anterior abdominal wall (black arrow).

Figure 2. (A) Abdominal CT scan reveals an abdominal abscess communicating with the sigmoid colon (black arrow) and mesh fixating materials identified in the left inguinal area. (B) Intraoperative photograph indicating sigmoid colon erosion (black arrow) by left inguinal mesh (white arrow).