Sigmoid to scrotal fistula secondary to mesh erosion: a rare complication of inguinal hernia repair in a patient on anticoagulation

BMC Surgery

Ali H. Hallal¹  Mustapha El Lakis¹  Maen Aboul Hosn¹  Jad A. Degheili¹ 

[1] Department of Surgery, Division of General Surgery, American University of Beirut–Medical Center, Riad El Solh 1107 2020, Beirut, Lebanon

关键词: Sepsis;    Fistula;    Mesh erosion;    Mesh infection;    Hernia;   

Others  :  1222716
DOI  :  10.1186/s12893-015-0070-9

 received in 2015-02-18, accepted in 2015-06-29,  发布年份 2015

【 摘 要 】

Background

Few reports from the medical literature have presented severe mesh-related complications following laparoscopic repair of inguinal hernia. One of these complications is being mesh erosion into bowel, resulting in fistulous tract with subsequent abscess formation.

Case presentation

A 75-year-old patient, status post laparoscopic bilateral inguinal hernia repair, and on anticoagulation for dual prosthetic heart valves, presented with a unique case of sigmoid to scrotal fistula, post mesh erosion, resulting in sepsis. The patient presented in septic shock, necessitating an individualized surgical approach. Given the septic picture of our patient, the surgical approach was truncated. Initially the sepsis from the scrotum was drained and debrided. A watermelon seed was noted in the scrotum. After stabilization, the second stage approach was performed, were a laparotomy was performed, followed by division of the sigmoid to internal ring fistula, and reperitonealization of the mesh. Mesh removal was delayed as the risk of bleeding into the peritoneum was high, once anticoagulation needed to be resumed. Because of a persistent wound sinus tract, several months later, the mesh was removed, in a third stage, from an inguinal incision. Albeit meticulous dissection and homeostasis, a postoperative extraperitoneal inguinal hematoma developed, as expected, on day 2, once anticoagulation was resumed.

Conclusion

Sigmoid to inguinoscrotal fistula is a rare, yet serious, complication of mesh infection and erosion. This can be obviated by preventing serosal tear, and proper peritonealization of the mesh. Fistulectomy alone with primary repair turned out to be a valid approach in our patient. Retaining the mesh could be an alternative for avoiding bleeding in patients on anticoagulation; despite that a persistent indolent infection and sinus tract will necessitate mesh removal afterwards.

【 授权许可】

   
2015 Degheili et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

【 参考文献 】

• [1]Zubaidi A, Saghier MA, Kabbani M, Abdo A. Colocutaneous fistula after mesh plug inguinal hernia repair- a delayed complication. Ann Saudi Med. 2006; 26(5):385-7.
• [2]Usher FC, Ochsner J, Tuttle LL. Use of Marlex mesh in the repair of incisional hernias. Am Surg. 1958; 24(12):969-74.
• [3]Lichtenstein IL, Shulman AG. Ambulatory outpatient hernia surgery. Including a new concept, introducing tension-free repair. Int Surg. 1986; 71(1):1-4.
• [4]Rutkow IM, Robbins AW. “Tension-free” inguinal herniorrhaphy: A preliminary report on “mesh-plug” technique. Surgery. 1993; 114:3-8.
• [5]Murphy JW, Misra DC, Silerglide B. Sigmoid colonic fistula secondary to Perfix-plug, left inguinal hernia repair. Hernia. 2006; 10(5):436-8.
• [6]Klein AM, Banever TC. Enterocutaneous fistula as a postoperative complication of laparoscopic inguinal hernia repair. Surg Laparosc Endosc. 1999; 9(1):60-2.
• [7]Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. The tension-free hernioplasty. Am J Surg. 1989; 157(2):188-93.
• [8]Amid PK. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia. 1997; 1:15-21.
• [9]Han HJ, Kim CY, Choi SB, Kwak JM, Lee SI. Sigmoid colon fistula following totally extraperitoneal hernioplasty: an improper treatment for mesh infection or iatrogenic injury? Hernia. 2010; 14(6):655-8.
• [10]Sahoo MR, Bisoi S, Mathapati S. Polypropelene mesh eroding transverse colon following laparoscopic ventral hernia repair. J Minim Access Surg. 2013; 9(1):40-1.
• [11]Fernandez Lobato R, Martinez Santos C, Ortega Deballon P, Fradejas López JM, Marin Lucas FJ, Moreno Azcoita M. Colocutaneous fistula due to polypropylene mesh. Hernia. 2001; 5(2):107-9.
• [12]Rajamanickam S, Yadav A, Rai A, Singh D, Sonkar AA. A complicated true sliding hernia presenting as a spontaneous enteroscrotal fistula in an adult. J Emerg Trauma Shock. 2010; 3(1):62-5.
• [13]Lauwers P, Bracke P, Hubens G, Vaneerdeweg W. Unusual complications of preperitoneal mesh implantation in the treatment of inguinal hernia. Acta Chir Belg. 2003; 103(5):513-6.
• [14]Lee J, Stein SL. Radiographic and endoscopic diagnosis and treatment of enterocutaneous fistulas. Clin Colon Rectal Surg. 2010; 23(3):149-60.
• [15]Tϋney D, Altun E, Barles A, Yegen C. Pancreatico-colonic fistula after acute necrotizing pancreatitis. Diagnosis with spiral CT using rectal water soluble contrast media. JOP. 2008; 9(1):26-9.
• [16]Miller K, Junger W. Ileocutaneous fistula formation following laparoscopic polypropylene mesh hernia repair. Surg Endosc. 1997; 11(7):772-3.
• [17]Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2011; 7(9):CD001544.
• [18]Canonico S, Sciaudone G, Pacifico F, Santoriello A. Inguinal hernia repair in patients with coagulation problems: Prevention of postoperative bleeding with human fibrin glue. Surgery. 1999; 125(3):315-7.
• [19]Canonico S, Benevento R, Perna G, Guerniero R, Sciaudone G, Pellino G et al.. Sutureless fixation with fibrin glue of lightweight mesh in open inguinal hernia repair: Effect on postoperative pain: A double-blind, randomized trial versus standard heavyweight mesh. Surgery. 2013; 153(1):126-30.
• [20]Moorthy K, Shaul T, Foley RJE. The laparoscopic management of benign bowel fistulas. JSLS. 2009; 8:356-8.
• [21]Kusunoki M, Ikeuchi H, Yanagi H, Shoji Y, Yamamura T. Stapled fistulectomy to treat enteroenteric fistulas in Crohn’s disease. Surg Today. 1997; 27:574-5.