P-021 DELAYED ENTEROCUTANEOUS FISTULA AND ENCAPSULATING MESH INFECTION AFTER COMPOSITE MESH REPAIR OF AN ABDOMINAL MIDLINE INCISIONAL HERNIA - COMPLICATIONS 12 YEARS LATER

Abstract

Abstract Aim Mesh infection is a well-recognised complication of incisional hernia repair, however, is usually encountered within months after mesh insertion. Only a few cases have been published where an enterocutaneous fistula has presented many years after mesh repair of an incisional hernia. Here we describe a complicated case of enterocutaneous fistula and mesh infection 12 years after the primary surgery. Material & Methods A 44 year-old gentleman presented acutely with a worsening 4 month history of an umbilical discharging sinus with associated fever, intermittent abdominal pain and nausea. There was also an associated hard lump and skin erythema. He previously had a laparotomy, small bowel resection for tuberculosis and ileostomy formation 13 years ago, followed by ileostomy reversal and intraperitoneal incisional hernia repair with composite mesh 1 year later. Results Cross-sectional imaging showed a large volume of gas within the mesh with underlying small bowel and collection within anterior abdominal wall, suggesting an enterocutaneous fistula. The patient initially underwent ultrasound guided aspiration of the collection followed by nutritional optimisation prior to another laparotomy, mesh excision and small bowel resection. The mesh was found to have a thick biofilm initially thought to be encased in mycobacterium but further testing was negative for this. Conclusions Delayed mesh infection over more than a decade after mesh insertion is rare. It is likely that pre-existing risk factors such as previous TB and small bowel resection with adhesions increased the risk of enterocutaneous fistulation.