An unusual cecal mass on routine colonoscopy

Area of Science:

• Gastroenterology
• Surgical Oncology
• Abdominal Imaging

Background:

• Cecal masses are uncommon, and those caused by external compression are particularly rare.
• Inguinal hernia repair using mesh prosthetics is a common surgical procedure.

Observation:

• A 72-year-old male presented with a cecal mass detected during colonoscopy, with biopsies revealing normal colonic mucosa.
• Previous surgery included a bilateral open inguinal hernia repair utilizing the 'Plug-and-Patch' mesh system.
• CT imaging identified a 4 x 3.3 cm mass compressing the cecal wall, raising concern for neoplasm.

Findings:

• Diagnostic laparoscopy with intraoperative colonoscopy revealed an undescended right hernia plug causing extrinsic compression of the cecal wall.
• The misplaced mesh plug created an intraluminal impression within the cecum during colonic insufflation.

Implications:

• This case highlights the diagnostic utility of combining laparoscopy with intraoperative colonoscopy for indeterminate colonic masses.
• It underscores the potential for rare complications from mesh-based hernia repairs, emphasizing thorough surgical assessment.
• Accurate diagnosis of extrinsic colonic compression requires a comprehensive approach, integrating imaging and surgical visualization.