Pelvic pseudolesions after inguinal hernioplasty using prosthetic mesh: CT findings

To investigate frequency and morphology of focal pelvic lesions (FPLs) in patients after open inguinal hernioplasty with a prosthetic mesh.

Patients who had open prosthetic inguinal hernioplasties between 1999 and 2004 and subsequent pelvic computed tomography were identified. Computed tomography of each patient was evaluated by 2 observers. The presence of an FPL at the internal inguinal ring (IIR) and its shape, size, and attenuation were recorded. The findings were compared with the type of surgical mesh used for the repair.

There were 93 patients, 86 men, with a mean age of 62.4 years (range, 14-89 years) who underwent 96 hernioplasties, with plug or flat mesh used in 71 and 25 cases, respectively. There were 96 computed tomographies obtained between 1 and 46 months (mean, 15.4 months) after surgery. Focal pelvic lesions were identified in 69 (72%) of 96 cases. Focal pelvic lesions were found in 63 (89%) of 71 cases repaired with a plug, but in only 6 (24%) of 25 cases repaired with a flat mesh (P < 0.0001). One hundred percent of FPLs corresponded to the surgical site and were located deep to the IIR. Focal pelvic lesions were ovoid or round in 65 (94%) and 4 (6%) cases, respectively; all were well defined. Focal pelvic lesions had a mean diameter of 2.4 cm (range, 1.3-3.9 cm) and mean attenuation value of 17 Hounsfield units (range, -4 to 64 Hounsfield units).

A low attenuation, ovoid, or round FPL located at the IIR is a common postoperative finding in patients after open inguinal hernioplasty performed with a plug mesh.