Delayed mesh infection after inguinal hernia repair: a case report
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Published on: December 23, 2022
Homare Ito1, Kenji Matsumoto1, Toshiaki Terauchi1
1Department of Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan.
Abstract:
Delayed deep mesh infection is a rare complication and the precise mechanism of its development is unknown. We report a case of delayed deep mesh infection after inguinal hernia repair. A 65-year-old man was admitted for treatment of colon cancer. He had a history of bilateral hernioplasty repaired with mesh-plugs 6 years previously. Fluorine-18 fluorodeoxyglucose positron emission tomographic scan showed positive findings in the right inguinal region similar to cancer. He had no complaints or findings to suspect mesh infection. Postoperative computed tomography scan over time revealed a fluid collection with inflammation. Eleven years after hernia repair, the patient presented with inflammation in the right inguinal region and emergency operation was performed. An abscess cavity was found and the mesh-plug covered with granulation tissue was removed. The patient remains free of recurrence of inguinal hernia or inflammatory changes after 3 years of follow-up.
Insights
Delayed deep mesh infection after inguinal hernia repair is rare. This case highlights a late-onset infection, presenting as an abscess 11 years post-surgery, requiring mesh removal.
Area of Science:
- Medical Science
- Surgical Innovation
- Infectious Disease
Background:
- Delayed deep mesh infection is a rare complication following inguinal hernia repair.
- The exact mechanisms driving late-onset mesh infections remain poorly understood.
- Early diagnosis can be challenging, often mimicking other conditions.
Purpose of the Study:
- To report a unique case of delayed deep mesh infection after inguinal hernia repair.
- To illustrate the diagnostic challenges and clinical presentation of late-onset mesh infections.
- To highlight the successful management and long-term outcome of such a complication.
Main Methods:
- A case study of a 65-year-old male patient with a history of bilateral hernioplasty.
- Utilized Fluorine-18 fluorodeoxyglucose positron emission tomographic (FDG-PET) scan and serial computed tomography (CT) scans for diagnosis.
- Performed emergency surgery for abscess removal and mesh excision.
Main Results:
- The patient presented with inflammation 11 years after initial mesh-plug repair.
- FDG-PET scan showed suspicious findings in the inguinal region, initially concerning for malignancy.
- Serial CT scans revealed an evolving fluid collection indicative of inflammation, leading to surgical intervention.
- An abscess containing the mesh-plug was successfully removed, with no recurrence after 3 years.
Conclusions:
- Delayed deep mesh infection can occur many years after inguinal hernia repair.
- Multimodal imaging, including FDG-PET and CT, is crucial for diagnosing subtle late-onset infections.
- Prompt surgical intervention involving mesh removal is effective in managing these rare complications.
- Complete resolution and absence of recurrence were achieved post-excision.
