A Diagnostic Dilemma of a Discharging sinus over the Anterior Abdominal Wall

Abstract

Chronic mesh infection is one of the most challenging clinical conditions in the abdominal wall surgery. Whether an infected mesh must be totally removed or not, the role of antibiotics, the right timing for a repair and guidelines on how to treat the abdominal wall must be discussed. Incidences of mesh-related infection after herniare pair of up to 8% have been reported. The rate of infection is influenced considerably by underlying co-morbidity, and seems to be increased in patients with diabetes, immunosuppression or obesity. A clinician should strongly consider the possibility of a mesh-related infection in any patient who presents with fever of unknown aetiology, symptoms and ⁄ or signs of inflammation of the abdominal wall in the area of the mesh, or other less common clinical manifestations of mesh infection, such as an enterocutaneous fistula or abdominal abscess in the area of the mesh. Imaging techniques, including ultrasound and ⁄ or computerised tomography, can be useful for the diagnosis of mesh infection. When a mesh-related infection occurs, a combined medical and surgical approach involving intravenous antimicrobial agents and complete surgical removal of the mesh is the preferred management strategy.