Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2022; 10(12): 3944-3950
Published online Apr 26, 2022. doi: 10.12998/wjcc.v10.i12.3944
Mesh plug erosion into the small intestine after inguinal hernia repair: A case report
Tian-Hao Xie, Qiang Wang, Si-Ning Ha, Shu-Jie Cheng, Zheng Niu, Xiang-Xiang Ren, Qian Sun, Xiao-Shi Jin
Tian-Hao Xie, Qiang Wang, Si-Ning Ha, Shu-Jie Cheng, Zheng Niu, Xiang-Xiang Ren, Qian Sun, Xiao-Shi Jin, Department of General Surgery, the Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China
Author contributions: Xie TH and Jin XS contributed to the drafting of the manuscript and revising the final draft; Wang Q and Ha SN contributed to the acquisition of data and revising the final draft; Cheng SJ, Niu Z, Ren XX and Sun Q contributed to the investigation and interpretation of the data; all authors have read and approved the manuscript.
Supported by the Medical Science Research Project of Hebei Provincial Health Commission, No. 20211642; and Key Research and Development Project of Hebei Province, No.21377773D.
Informed consent statement: Written consent for publication was acquired from the patient, and the signed consent will be provided upon request.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Shi Jin, MD, PhD, Dean, Surgeon, Department of General Surgery, the Affiliated Hospital of Hebei University, No. 212 East Yuhua Road, Baoding 071000, China. doctorjinxiaoshi@126.com
Received: October 21, 2021
Peer-review started: October 21, 2021
First decision: December 17, 2021
Revised: December 23, 2021
Accepted: March 6, 2022
Article in press: March 6, 2022
Published online: April 26, 2022
Processing time: 182 Days and 4.8 Hours
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: Mesh plug; Inguinal hernia repair; Migration; Erosion; Complication; Case report

Core Tip: Mesh plug (MP) erosion into the intra-abdominal organs is a rare but serious long-term complication after inguinal hernia repair. We report a rare case of MP erosion into the small intestine to improve surgeons’ knowledge regarding this complication. MP erosion should be included in the differential diagnosis of patients with a history of inguinal hernia repair who present with abdominal pain and the need for longer follow-up to detect MP erosion. When MP erosion is diagnosed, the most effective treatment is removal of the mesh and resection or repair of the involved organs.