Abstract
Ventral hernia repairs are commonly treated by abdominal wall repair where a prosthetic mesh is placed over the hernia site, to prevent future hernia recurrences. Risks of a ventral hernia repair include urinary retention, seroma, recurrence, and in rare cases, bowel injury or obstruction. Our patient’s clinical presentation and history, supported by an abdominal X-ray and CT findings, were consistent with the diagnosis of small bowel obstruction (SBO) due to adhesions between the patient’s small bowel and the mesh used for abdominal wall hernia repair. Our patient underwent an exploratory laparotomy due to exquisite abdominal wall tenderness and evidence of SBO. Appropriate identification of the cause of our patient’s SBO, careful and meticulous treatment, and appropriate inpatient monitoring all contributed to a successful outcome.
Highlights
Hernia repair often involves the use of prosthetic mesh placed over the hernia site rather than simple suturing to prevent re-herniation [1]
Mesh is associated with hernia recurrence and in rare cases may adhere to the small bowel adjacent to it
Complications from abdominal wall mesh after hernia repair are relatively uncommon, and of these, small bowel obstruction (SBO) is even less common; a 2003 paper reported that in a series of 850 patients treated for ventral hernia, the complications of ileus, prolonged seroma, intestinal injury, mesh infection, and hematoma occurred in 3%, 2.6%, 1.7%, 0.7%, and 0.4% of patients, respectively [4]
Summary
Hernia repair often involves the use of prosthetic mesh placed over the hernia site rather than simple suturing to prevent re-herniation [1]. Adhesions between mesh and abdominal viscera are a potential complication following surgery with intra-abdominal prosthetic mesh placement. We present a case in which a 65-year-old male with a past medical history of ventral hernia repair with mesh four years prior to presentation, as well as multiple instances of small bowel obstruction (SBO) since his hernia repair, presented with progressively worsening abdominal pain and a lack of bowel movements for three days. CT showed decompressed distal and terminal ileum consistent with SBO, as well as soft tissue thickening within the central abdomen deep to the umbilicus in a region of dilated and decompressed ileum, which could possibly be the cause of obstruction and perhaps due to adhesions or mass (Figure 2). The postoperative diagnosis was SBO due to adhesions with abdominal wall and ventral hernia mesh. The patient was discharged home on the fourth postoperative day and followed in an outpatient setting
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