Intraluminal Migration of Surgical Mesh With Retained Metallic Tacks Causing Small Bowel Obstruction After Ventral...

Mesh repair is commonly used for abdominal wall hernias. However, mesh-related complications, including infection, adhesion formation, and migration, remain important considerations. Mesh migration into the gastrointestinal tract represents an uncommon delayed postoperative complication that can manifest long after the initial surgical repair. Patients may experience a range of gastrointestinal symptoms depending on the location and extent of migration. We report a case of small bowel obstruction caused by intraluminal migration of surgical mesh with retained metallic fixation tacks. A 60-year-old male with a history of prior abdominal surgeries, including abdominoplasty and laparoscopic surgery for bowel obstruction approximately 15 years earlier, presented with worsening colicky abdominal pain, nausea, and vomiting. A CT of the abdomen and pelvis demonstrated a mechanical small bowel obstruction with a heterogeneous intraluminal density in the distal ileum. Exploratory laparotomy revealed dense adhesions and a firm intraluminal foreign body measuring approximately 7 cm within the distal ileum. The foreign body was identified as folded surgical mesh with embedded metallic fixation tacks that had migrated intraluminally. The affected bowel segment was resected, and a stapled anastomosis was performed. The postoperative course was complicated by prolonged ventilatory support and intra-abdominal abscesses requiring percutaneous drainage, after which the patient improved clinically. Intraluminal mesh migration is an uncommon but clinically important cause of small bowel obstruction that should be considered in patients with prior hernia repair presenting with obstructive symptoms, particularly when imaging demonstrates an intraluminal foreign body. Surgical management is often necessary and may carry significant morbidity due to dense adhesions and the need for bowel resection. A high index of clinical suspicion is essential for timely diagnosis and appropriate operative planning.