Posterior rectus abdominis sheath abscess after tension-free vaginal tape

Tension-free vaginal tape (TVT) is commonly used to treat stress urinary incontinence (SUI). TVT is known for its simplicity of use and successful outcomes with low morbidity [1]. However, complications can occur. We report an abscess posterior to the rectus muscle following TVT. A 46-year-old woman underwent TVT for SUI. On postoperative day (POD) 13, she presented with an abscess of the left suprapubic incision, which was treated with antibiotics and drainage. She represented on POD 22 with multiple pulmonary emboli and sepsis, and computed tomography (CT) revealed a multiloculated abdominal-wall fluid collection deep to the rectus muscle. The mesh was removed via vaginal incision. The rectus sheath abscess was accessed through a subfascial but extraperitoneal midline incision. The abdominal-wall wound was connected to the suprapubic wound. Whereas major infectious complications of TVT are rare, when they do occur, debridement, drainage, and removal of the mesh are imperative to prevent morbidity.