Asymptomatic plug erosion into the sigmoid colon after mesh plug hernia repair: A case report

Mesh plug (MP) inguinal hernia repair is a technique associated with less postoperative pain and low recurrence. However, postoperative gastrointestinal complications due to plug erosion or migration have been reported. This report discusses a case of asymptomatic plug erosion into the sigmoid colon.

A 75-year-old male underwent a computed tomography (CT) scan due to abnormal results during lung cancer screening. He previously underwent MP hernia repair for bilateral inguinal hernias 19 years ago. Incidentally, CT scan revealed a hypodense mass in the left inguinal region with internal gas in traffic with the sigmoid colon. Plug erosion into the sigmoid colon was diagnosed. Partial resection of the sigmoid colon was done by removing the plug, and the Hartmann procedure was done to avoid leakage and infection. The on-lay patch was preserved because it was not infected. Two years postoperatively, there was no evidence of infection or recurrence of the inguinal hernia.

This is the first reported asymptomatic case of plug erosion into the sigmoid colon. The patient was diagnosed later than other cases and had no risk factors (e.g., sigmoid diverticulum). The patient was asymptomatic likely because the plug was very slowly eroding into the normal sigmoid colon.

Serious complications due to erosion and migration of the plug may occur after MP hernia repair, but this may be asymptomatic in some cases.