Extrinsic Cecal Compression and Abdominal Pain Caused by a Migrated Inguinal Mesh Plug

Abstract

AIM: To describe a case of extrinsic cecal compression and abdominal pain caused by a migrated inguinal mesh plug. CASE REPORT: A 59 yo male presented for surveillance colonoscopy, given a prior history of adenomatous colon polyps. His past medical history was unremarkable. From the surgical perspective, he had undergone prior right inguinal herniorraphy with polypropylene mesh inguinal plug placement several years previously. After informed consent was obtained, colonoscopy was performed under moderate sedation to the cecum with ileal intubation. The exam was unremarkable aside from there being and ˜ 1.5 cm area of extrinsic compression noted over the lateral wall of the cecum. The colon wall was able to be retracted from this area with grasping forceps, and overlying colon mucosa was normal and it was apparent that this finding was not related to an epithelial colon lesion. Given the endoscopic findings, a subepithelial intrinsic colon lesion was also thought to be unlikely. Upon reviewing the colonoscopic findings with the patient, he did endorse a 1 year history of aching and episodic right lower quadrant pain which had no precipitating, exacerbating or mitigating factors. A CT scan of the abdomen and pelvis was interpreted by the radiologist to be normal. The general surgeon who was consulted was concerned that there may have been migration of a previously placed inguinal mesh plug. Laparoscopy was recommended. At laparoscopy, a migrated inguinal mesh plug was found adherent to the cecum. The mesh plug was removed laparoscopically and the patient recovered uneventfully. His chronic aching abdominal pain resolved after 2 years of follow-up. CONCLUSION: Inguinal mesh plugs can rarely migrate into the abdomen and cause bowel complications. In the patient described in this report, laparoscopic removal of the migrated mesh plug was associated with durable resolution of chronic right lower quadrant pain.