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Late-Onset Mesh Infection Manifesting as Preperitoneal Abscess and Cutaneous Fistula Post-TEP Inguinal Hernia Repair: A Case Report.
- Source :
-
The American journal of case reports [Am J Case Rep] 2024 Jul 30; Vol. 25, pp. e944843. Date of Electronic Publication: 2024 Jul 30. - Publication Year :
- 2024
-
Abstract
- BACKGROUND Endoscopic inguinal hernia repair has become the preferred technique currently. The use of mesh to facilitate a tension-free reinforcement has become the standard of care during endoscopic totally extraperitoneal (TEP), laparoscopic transabdominal pre-peritoneal, and open inguinal hernia repair. Although uncommon, late-developing mesh infections, defined as those occurring in the surgical site months or years after the procedure, can lead to severe complications. To achieve the best possible outcome for the patient, prompt imaging and a multidisciplinary approach to management, including complete surgical removal of the contaminated mesh and proper antibiotic therapy, are crucial. CASE REPORT A 39-year-old woman presented with a 1-month history of intermittent fever, progressive lower abdominal pain and fullness, and purulent discharge from the abdominal wall. Her medical history was significant for an endoscopic right TEP inguinal hernia repair performed 3 years earlier, which involved the use of an anatomic mesh and titanium screws. Physical examination and ultrasound findings revealed a large preperitoneal abscess with cutaneous fistulization, secondary to a deep-seated mesh infection. Pseudomonas aeruginosa was identified as the causative pathogen. She underwent a 2-step surgical procedure, including an initial fistulectomy followed by endoscopic abscess drainage and surgical excision of the infected mesh, combined with antimicrobial therapy, resulting in an excellent clinical response and complete resolution. This strategy also allowed for an effective assessment of the abdominal wall integrity. CONCLUSIONS This case underscores the importance of considering late-developing mesh infections in patients presenting with abdominal symptoms who have previously undergone TEP hernia repair, even years after the initial surgery.
- Subjects :
- Humans
Female
Adult
Herniorrhaphy adverse effects
Abscess microbiology
Abscess etiology
Pseudomonas Infections etiology
Surgical Wound Infection microbiology
Surgical Wound Infection etiology
Surgical Wound Infection therapy
Abdominal Abscess etiology
Abdominal Abscess microbiology
Hernia, Inguinal surgery
Surgical Mesh adverse effects
Cutaneous Fistula etiology
Cutaneous Fistula microbiology
Subjects
Details
- Language :
- English
- ISSN :
- 1941-5923
- Volume :
- 25
- Database :
- MEDLINE
- Journal :
- The American journal of case reports
- Publication Type :
- Academic Journal
- Accession number :
- 39075786
- Full Text :
- https://doi.org/10.12659/AJCR.944843