Mesh Migration in to Colonic Lumen Post Abdominal Hernia Repair: A Case Report

Special Article - Surgical Case Reports

Austin J Surg. 2017; 4(1): 1095.

Mesh Migration in to Colonic Lumen Post Abdominal Hernia Repair: A Case Report

Ahmed Kharief*

Surgical Department, Louth County Hospital, Ireland

*Corresponding author: Ahmed Kharief, Surgical Department, Louth County Hospital, 3 Ashfield Crescent North Road Drogheda Co Louth, Ireland

Received: February 01, 2017; Accepted: February 17, 2017; Published: February 22, 2017


Incisional hernia formation following secondary to abdominal surgeries is a common complication. Laparoscopic mesh repair recently has gained significant publicity for such hernia repair. However, utilizing polypropylene mesh for incisional hernia repair, can lead to variety of complications from minor postoperative hematoma and seroma to mesh rejection and fistula formation. However, mesh migration is an infrequent occurrence and has been rarely reported in the literature. Additionally, review of literature shows mesh migration to urinary bladder, scrotum and caecal lumen. We present a case of delayed partialtrans mural mesh migration from the abdominal wall into colonic lumen, following laparoscopic mesh repair of abdominal incisional hernia. This is the first case of mesh migration that has been successfully managed conservatively.

Keywords: Hernioplasty complication; Mesh migration; Cecum erosion; Chronic abdominal pain

Case Report

We present a 65-year-old, female, with background history of gallstone pancreatitis, open pancreatic necrosectomy and cholecystectomy 5years ago (2008), underwent open mesh repair for incisional hernia in August 2010 at another centre. The hernia was located at medial aspect of left sub-coastal (Kocher’s) laparotomy scar. However, patient later developed incisional hernia at lateral aspect of the same laparotomy scar, for which she underwent Total Extra-Peritoneal hernia repair (TEP) at our surgical department in July 2011. Partietex composite mesh was applied to the 8 × 8 cm hernial defect. Peri-operative course was uneventful. She re-attended surgical outpatient department in April 2014, with complains of ongoing right iliac fossa pain and bloating. She described the pain to be intermittent, dull ache, non-shifting, non-radiating, gradually worsening, with no associated aggravating or relieving factors. She denied any history of nausea, vomiting, diarrhoea, intermittent fever or per-rectal bleed. The pain was not related to food consumption or occurred at any particular timing. She had no recent weight loss. There was no similar history in the past. She did not have any significant family history of colorectal cancer. Her past medical history revealed left leg great saphenous varicose veins surgery (2002), colonoscopy showed sigmoid diverticulosis (2006), gall stones related pancreatitis (2007) large pancreatic pseudo cyst, followed by laparotomy with cholecystectomy and cystjujenostomy cyst drainage (2008). She is a non-smoker and consumed alcohol in moderation. Abdominal examination was unremarkable except for slight tenderness at right iliac fossa.

Radiology workup showed unremarkable plain abdominal-rays, ultrasound and Intravenous pyelogram. Patient was scheduled for colonoscopy on 16th of July 2014. During the colonoscopy, a fixed foreign body appeared in the colonic lumen with apparent metallic tacker attached to its (Figure 1). Given her past medical history, mesh migration into colonic lumen was suspected. The defect was well sealed off and no signs of peritonitis or bleeding were apparent. However chronic inflammation around the mesh with fibrosis of the colonic mucosa was obvious (Figure 2). Patient underwent CTabdomen and pelvis, which showed foreign body in transverse colon, signifying the presence of intra-luminal mesh.