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Mesh Antibioma: A New Entity in the Presentation of Late-Onset Mesh Infection
Ashwin Jain1, Chandrashekhar Mahakalkar1, Suhas Jajoo1
1Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.
Abstract:
Antibioma is a tough-walled abscess, which usually forms as a sequela of inadequate or lack of pus drainage during infection and inappropriate use of antibiotics by the patient. In this case report, we present a case of the development of antibioma due to infected polypropylene mesh used in umbilical hernia repair 10 years ago in a 59-year-old obese male. He had a history of umbilical and right inguinal hernioplasty 10 years back. Intraoperatively, we found antibioma whose wall was made up of fibrous mesh and the center was filled with pus and nonfibrous mesh remnants. The pus was found to be sterile, and the wall was made up of fibromuscular adipose tissue with chronic inflammatory cells around it. This is a very rare presentation of umbilical site deep mesh infection as it had no signs of acute inflammation, neither pain nor any pus discharge. We conclude that the possible explanation for the formation of antibioma and its very delayed presentation could be due to mesh infolding and seroma/hematoma formation during previous surgery may have led to the formation of abscess and thick fibrous wall without any fistulous tract and other complications of deep mesh infection.
Insights
A rare case of antibioma, a walled-off abscess, developed 10 years after umbilical hernia repair. This deep mesh infection presented without acute inflammation, highlighting delayed complications from surgical mesh.
Area of Science:
- Surgical Pathology
- Infectious Diseases
- Biomaterials Science
Background:
- Antibioma, a walled-off abscess, typically results from inadequate infection drainage and antibiotic misuse.
- Deep mesh infections can present insidiously, complicating hernia repair outcomes.
Observation:
- A 59-year-old obese male presented with a delayed antibioma 10 years post-umbilical hernia repair using polypropylene mesh.
- Intraoperative findings revealed an antibioma with a fibrous mesh wall, pus, and non-fibrous mesh remnants.
- The abscess wall comprised fibromuscular adipose tissue with chronic inflammation; pus cultures were sterile.
Findings:
- This case represents a rare, delayed presentation of deep mesh infection at the umbilical site.
- Absence of acute inflammatory signs (pain, discharge) is a key characteristic of this presentation.
- Sterile pus and chronic inflammatory cells suggest a non-acute infectious or sterile inflammatory process.
Implications:
- Delayed antibioma formation may be linked to mesh infolding and seroma/hematoma from the initial surgery.
- This highlights the potential for long-term, subtle complications associated with surgical mesh implants.
- Understanding these delayed presentations is crucial for accurate diagnosis and management of chronic mesh-related issues.
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