Small bowel obstruction induced by migrated sacropexy mesh: a case report

Small bowel obstruction (SBO) is a frequent cause of surgical emergency, most commonly due to adhesions, hernias, or tumors. Mesh-related SBO following laparoscopic sacropexy is an exceptionally rare complication, often presenting years after the initial procedure and difficult to diagnose preoperatively.

We report a 69-year-old Caucasian woman with a history of laparoscopic sacropexy for cystocele repair using mesh eight years prior, presenting with abdominal pain, bilious vomiting, and distension. Laboratory tests revealed leukocytosis and elevated inflammatory markers. Abdominal radiography showed dilated small bowel loops, and computed tomography scan confirmed a mechanical SBO with a pelvic transition point, but the cause was unclear. Due to persistent symptoms despite medical management, laparoscopy was performed. Intraoperatively, a segment of small bowel mesentery was found incarcerated beneath a fibrous band, initially resembling an adhesion. Careful dissection revealed the band to be a migrated portion of the sacropexy mesh. The constricting segment was excised, the bowel released and inspected from the ligament of Treitz to the ileocecal valve, confirming viability and absence of additional lesions.

Mesh-related SBO is extremely rare, with mechanisms including migration, erosion, and adhesion formation. Preoperative diagnosis is challenging since mesh is often poorly visualized on CT. Laparoscopy offers both diagnostic and therapeutic advantages, enabling targeted management with reduced morbidity compared to laparotomy, but requires advanced expertise to minimize the risk of enterotomy in distended bowel.