Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2018; 6(12): 564-569
Published online Oct 26, 2018. doi: 10.12998/wjcc.v6.i12.564
Mesh migration into the sigmoid colon after inguinal hernia repair presenting as a colonic polyp: A case report and review of literature
Sha Liu, Xin-Xin Zhou, Lin Li, Mo-Sang Yu, Hong Zhang, Wei-Xiang Zhong, Feng Ji
Sha Liu, Xin-Xin Zhou, Lin Li, Mo-Sang Yu, Hong Zhang, Feng Ji, Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Wei-Xiang Zhong, Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Ji F designed the study; Liu S collected the patient’s clinical data and studied the relevant literature; Zhou XX, Zhong WX and Li L reviewed the data; Liu S analyzed the data and wrote the manuscript; Yu MS and Zhang H edited the manuscript and figures.
Supported by Zhejiang Provincial Natural Science Foundation of China, No. LQ16H030001.
Informed consent statement: The patient’s informed written consent was obtained, and approval was granted by the ethics committee of the First Affiliated Hospital, College of Medicine, Zhejiang University.
Conflict-of-interest statement: The authors declare no conflicts of interest related to the publication of this case report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Feng Ji, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. jifeng@zju.edu.cn
Telephone: +86-571-87236862
Received: June 28, 2018
Peer-review started: July 2, 2018
First decision: July 24, 2018
Revised: August 9, 2018
Accepted: August 30, 2018
Article in press: August 31, 2018
Published online: October 26, 2018
Processing time: 121 Days and 0.2 Hours
Abstract

Mesh migration and penetration into abdominal viscera rarely occur after laparoscopic inguinal hernia repair. We present the first case of mesh migration into the sigmoid colon identified as a colonic polyp at initial colonoscopic examination. The patient complained of mild abdominal distention in the lower abdomen over the previous year without changes in bowel habits or stool appearance and without weight loss. By complementary endoscopic ultrasonography, a cavity-like structure beneath the suspected polyp was further confirmed. Enhanced abdominal computed tomography merely revealed local bowel wall thickening and inflammation of the colosigmoid junction. The migrating mesh, which was lodged in the sigmoid colon and caused intra-abdominal adhesion in the lower abdominal cavity, was finally identified via exploratory surgery. The components of inflammatory granulation tissue around the mesh material were diagnosed based on histological examination of the surgical specimen after sigmoidectomy. In this patient, nonspecific endoscopic and imaging outcomes during clinical work-up led to the diagnostic dilemma of mesh migration. Therefore, the clinical, radiological and endoscopic challenges specific to this case as well as the underlying reasons for mesh migration are discussed in detail.

Keywords: Colonoscopy; Surgical mesh; Hernia repair; Sigmoid colon; Colonic polyps; Computed tomography; Foreign bodies

Core tip: Mesh migration and penetration into abdominal viscera are rarely reported as a long-term complication after inguinal hernia repair. In this case, a migrating prosthetic mesh penetrated the sigmoid colon in a 59-year-old male patient after bilateral inguinal hernioplasty. The migrating mesh mimicked a “colonic polyp” under endoscopy, while it was almost absent on radiological imaging and caused no obvious symptoms. This has never been reported in the previous literature, and it enhanced preoperative diagnostic difficulty. Therefore, clinical, radiological and endoscopic aspects of the case and, more importantly, the possible factors accounting for mesh migration and erosion are analyzed and summarized.