It's a Mesh in These Bowels: A Delayed Case of a Decade-Long Mesh Eroding Into the Small Bowel Causing Obstruction and Intraperitoneal Sepsis.

Abstract

The use of mesh has become standard practice for hernia repair as it facilitates a tension-free closure of the fascial defect and significantly reduces recurrence rates. However, rare but significant complications such as mesh migration can lead to intestinal obstruction, perforation, or enterocutaneous fistula. We present a case of transmural mesh migration from the abdominal wall into the small bowel, resulting in small bowel obstruction and intra-abdominal sepsis. A 66-year-old female patient with a history of umbilical hernia repair with mesh 10 years prior presented with worsening periumbilical bulge, nausea, vomiting, decreased appetite, and progressive erythema. She was hypotensive and tachycardic on arrival, requiring active resuscitation. Computed tomography (CT) imaging showed a 5 x 3 x 3 cm air and fluid collection and abnormal subjacent small bowel. Emergent laparotomy revealed mesh erosion into the small bowel, causing perforation and obstruction. Although mesh migration is rare, its consequences can be life-threatening. Surgeons should maintain a high index of suspicion in patients with prior mesh repair who present with signs of obstruction or sepsis.