Enterocutaneous Fistula and Abscess Diagnosed with Point-of-care Ultrasound

Area of Science:

• Medical Imaging
• Surgical Complications
• Gastroenterology

Background:

• Hernia repair with mesh can lead to rare, late-onset complications.
• Enterocutaneous fistula (ECF) and mesh infection are serious sequelae.
• Diagnosing these complications can be challenging, especially years after the initial surgery.

Purpose of the Study:

• To report a case of enterocutaneous fistula (ECF) and infected mesh diagnosed using point-of-care ultrasound (POCUS).
• To highlight the utility of POCUS in identifying complications of prior mesh hernia repair.
• To suggest POCUS as a valuable tool in the emergency department for evaluating suspected mesh infection and ECF.

Main Methods:

• A 64-year-old female with a history of mesh hernia repair presented with abdominal and flank pain.
• Point-of-care ultrasound (POCUS) was used to evaluate an abdominal wall mass.
• Computed tomography (CT) was performed for further diagnosis and confirmation.

Main Results:

• POCUS revealed an extraperitoneal fluid collection with intraperitoneal communication, suggestive of an abscess and infected mesh.
• CT confirmed the diagnosis of enterocutaneous fistula (ECF) with infected mesh and abdominal wall abscess.
• The patient received antibiotics and underwent source control.

Conclusions:

• Enterocutaneous fistula (ECF) and mesh infection are rare but serious complications of hernia repair, often presenting late.
• Point-of-care ultrasound (POCUS) may be a useful diagnostic tool for these complications, even when surgery was performed years prior.
• This case demonstrates that distant surgical history should not deter consideration of mesh infection and ECF, and POCUS can aid in their evaluation.