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Late-Onset Mesh Infection 10 Years After Right Inguinal Hernia Repair: A Case Report.

Ryoichi Shimizu1, Masahito Uji1, Hideo Matsubara1

  • 1Department of Surgery, Yachiyo Hospiral, Anjo, Aichi, Japan.

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Summary

Late-onset mesh infection years after inguinal hernia repair, caused by an appendiceal fistula, presents a rare surgical challenge. Complete mesh removal is crucial for successful treatment and preventing recurrence.

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Area of Science:

  • Surgical Innovation
  • Gastroenterology
  • Infectious Disease

Background:

  • Late-onset mesh infection following inguinal hernia repair is rare, with delayed onset years post-surgery being exceptionally uncommon.
  • Identified risk factors include surgical site contamination, patient comorbidities (diabetes, steroid use), and fistulas involving adjacent organs.

Purpose of the Study:

  • To present a rare case of delayed mesh infection secondary to an appendiceal fistula after inguinal hernia repair.
  • To discuss the diagnostic and management challenges associated with such complex cases.

Main Methods:

  • A case report detailing an 86-year-old male with a decade-old inguinal hernia repair who developed a mesh infection.
  • Diagnostic imaging (CT scans) and colonoscopy were used to identify an appendiceal tumor causing a fistula.
  • Treatment involved ileocecal resection with staged mesh removal and negative-pressure wound therapy.

Main Results:

  • An appendiceal adenoma obstructed the appendiceal orifice, forming a fistula to the abdominal wall and causing delayed mesh infection.
  • Initial ileocecal resection with mesh in situ did not resolve the infection, necessitating further staged mesh removal.
  • Complete mesh excision and negative-pressure wound therapy ultimately led to healing without recurrence.

Conclusions:

  • This case underscores the complexity of managing mesh infections arising from appendiceal fistulas long after hernia repair.
  • Incomplete mesh removal significantly elevates the risk of recurrence and treatment duration, highlighting the importance of complete excision.