An Unusual Case of Ileitis and Partial Small Bowel Obstruction Secondary to Mesh Erosion After Totally Extraperitoneal Inguinal Hernia Repair

Abstract

The objectives were to highlight that: (1) mesh erosion related partial small bowel obstruction after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair (IHR) as an uncommon complication can clinically and radiologically mimic ileocolic Crohn's disease in young adults; and (2) implore clinicians to consider a broad set of differential diagnosis and prompt involvement of other subspecialties, especially if preliminary investigations and treatment yield minimal results. The authors report a 34-year-old male who presented with computed tomography (CT) findings of ileitis, which was initially investigated for Crohns' disease. Due to persisting abdominal pain and negative initial investigations, he underwent a laparotomy demonstrating secondary mesh migration with erosion into distal ileum requiring bowel resection, 2.5 years after an uneventful laparoscopic right TEP IHR. The patient made an uneventful postoperative recovery and at 6 weeks follow-up, he had resolution of abdominal pains, and normal bowel function.

Keywords: ileitis; laparoscopic extraperitoneal inguinal hernia repair; mesh erosion; small bowel obstruction.

Figure 1

Computed tomography (CT) scan demonstrating a long segment of distal small bowel wall thickening with mucosal hyperenhancement consistent with ileitis (arrows).

Figure 2

Colonoscopic pictures of normal ileal mucosa at the ileocaecal valve (a) and 60 cm proximal to the ileocaecal valve (b).

Figure 3

Intraoperative views of dense distal small bowel adhesion onto the mesh (a) and after adhesiolysis demonstrating erosion of mesh onto this small bowel segment that was subsequently resected (b).