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Complications unveiled: A detailed case report on mesh migration post-incisional hernia repair
Maissa Jallali1, Mohamed Ali Chaouch1, Hanen Zenati1
1Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia.
Introduction And Importance:
Repairing incisional abdominal wall hernia with nonabsorbable meshes is one of the most common procedures in general surgery. Mesh migration into the intestine is rare but a serious complication. It can occur months or even years after surgery and often presents with vague abdominal pain, making diagnosis tricky.
Case Presentation:
We report a rare case of a 52-year-old female presenting a small bowel obstruction secondary to mesh migration from the abdominal wall into the intestine, 10 years after repeated surgical repair of a ventral incisional hernia. At surgery, a mesh was migrated into a small bowl. The patient had a small bowel resection. The postoperative course was simple and the patient was discharged after 5 days.
Case Discussion:
Incisional hernia repair with mesh is one of the most commonly performed surgical procedures worldwide. Many complications have been linked to the use of mesh; among the most frequently reported are seromas, hematomas, and infections. Mesh migration remains an uncommon event after incisional hernia repair, and even rarer when considering complete migration within the intestinal lumen. The exact cause of this complication remains unknown. Multiple hypotheses have been proposed for mesh migration. Abdominal pain, intermittent or persistent intestinal obstruction, mass formation, and viscus perforation represent the most common clinical manifestation. Total removal of the mesh via laparoscopy or laparotomy is recommended, along with either partial or entire resection of the organ.
Conclusion:
Mesh migration is a an uncommon possible complication in case of incisional hernia mesh repair and it requires often surgical intervention.
Insights
Mesh migration into the intestine is a rare but serious complication following abdominal wall hernia repair. This case highlights the need for vigilance, as it can occur years post-surgery, often requiring surgical intervention.
Area of Science:
- General Surgery
- Gastroenterology
Background:
- Incisional hernia repair using nonabsorbable meshes is a prevalent surgical procedure.
- While effective, mesh use is associated with complications, including rare instances of migration into the gastrointestinal tract.
Observation:
- A 52-year-old female experienced small bowel obstruction 10 years after ventral incisional hernia repair.
- Surgical exploration revealed complete mesh migration into the small bowel, necessitating a small bowel resection.
Findings:
- Mesh migration into the intestine is an uncommon complication of incisional hernia repair, potentially occurring years after the initial surgery.
- Clinical presentations can be vague, including abdominal pain and obstruction, complicating diagnosis.
Implications:
- This rare complication underscores the importance of considering mesh migration in patients with a history of hernia repair presenting with gastrointestinal symptoms.
- Surgical intervention, including mesh removal and potentially bowel resection, is often required for management.
