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Discitis due to late-onset mesh infection 14 years after inguinal hernia repair: a case report
Chiyo Maeda1, Kai Kato2, Saki Yamada2
1Digestive Surgery, Yokohama Asahi Chuo General Hospital, 4-20-1, Wakabadai, Asahi-ku, Yokohama, 241-0801, Japan. maechiyo@hotmail.co.jp.
Background:
Mesh infection after inguinal hernia repair is a very rare complication. The incidence of late-onset mesh infection is approximately 0.1-0.2% of total hernia repair cases and can lead to serious complications if not treated promptly. Here, we report a rare case of discitis due to late-onset mesh infection, occurring 14 years after an inguinal hernia repair.
Case Presentation:
An 89-year-old man was brought to our hospital with right-sided abdominal pain and signs of hypoglycemia. He had a history of type 2 diabetes mellitus and had undergone inguinal hernia repair 14 years ago. Upon admission, laboratory tests revealed no elevated inflammatory markers. Computed tomography (CT) revealed a peri-appendicular abscess. Although the patient was administered empiric antibiotics, on day 3 of admission, his white blood cell count and C-reactive protein levels increased to 38,000/µl and 28 mg/dl, respectively. CT-guided drainage was attempted but was not successful. Escherichia coli was detected in both blood culture collections. On day 7 of admission, the patient complained of back pain; CT on day 10 revealed a peri-appendicular abscess with a soft tissue shadow anterior to the thoracic vertebrae at the 8th/9th level. Thoracic discitis, due to bacteremia originating from the mesh abscess, was suspected. We surgically resected the appendix, followed by removal of the plug and mesh abscess. The post-operative course of the patient was uneventful. For treating discitis, it is known that antibiotic therapy is required for a minimum of 6 weeks. Therefore, on the 30th day post-surgery, the patient was transferred to the orthopedic ward for continued treatment.
Conclusions:
This report discusses a rare case of late-onset mesh infection leading to thoracic discitis. Since late-onset mesh infection cannot be treated solely with antibiotics, expeditious surgery should be selected when subcutaneous drainage fails. When an immunocompromised patient with bacteremia has a complaint of back pain, purulent spinal discitis should also be suspected.
Insights
Late-onset mesh infection after inguinal hernia repair is rare but can cause serious issues like thoracic discitis. Prompt surgical intervention is crucial when antibiotics and drainage fail, especially in immunocompromised patients presenting with back pain.
Area of Science:
- Surgical Innovation
- Infectious Diseases
- Hernia Repair Complications
Background:
- Late-onset mesh infection following inguinal hernia repair is a rare complication, occurring in approximately 0.1-0.2% of cases.
- These infections can lead to severe outcomes if not managed promptly, with potential for widespread dissemination.
Purpose of the Study:
- To report a unique case of thoracic discitis stemming from a late-onset mesh infection 14 years post-inguinal hernia repair.
- To highlight the diagnostic and therapeutic challenges associated with such rare presentations.
Main Methods:
- A case presentation of an 89-year-old male with a history of type 2 diabetes mellitus and prior inguinal hernia repair.
- Initial presentation with abdominal pain and hypoglycemia, evolving to peri-appendicular abscess and subsequent thoracic discitis.
- Surgical management involving appendiceal resection and mesh abscess removal, followed by prolonged antibiotic therapy.
Main Results:
- The patient developed a peri-appendicular abscess and bacteremia (Escherichia coli), later progressing to thoracic discitis.
- Initial antibiotic treatment and CT-guided drainage were unsuccessful.
- Surgical intervention led to an uneventful post-operative recovery, with transfer for extended antibiotic treatment of discitis.
Conclusions:
- Late-onset mesh infections require prompt surgical management when conservative measures like antibiotics and drainage fail.
- Thoracic discitis should be suspected in immunocompromised patients with bacteremia who develop back pain, particularly those with a history of mesh implantation.
- Early surgical intervention is critical for successful treatment outcomes in complex mesh infection cases.
