S1713 Surgical Mesh Protrusion Through the Transverse Colon Masquerading as a Colonic Mass

Abstract

Introduction: The differential diagnosis for abdominal pain in the setting of prior abdominal surgery is vast. Within general surgery, hernia repair is a frequently performed procedure and use of mesh has been shown to reduce the overall rate of recurrence. Unfortunately, mesh implantation is associated with many potential complications and risks. Having a high index of suspicion for the proper differential diagnosis is critical, so diagnosis is not delayed and the appropriate management can be started. We present the case of a female patient who presented with epigastric pain and was found to have surgical mesh from prior hernia repair perforating through the colon. Case Description/Methods: This is a 52 y/o female with PMH of pancreatic cancer, s/p Whipple procedure and abdominal hernia s/p repair presenting with complaints of dull epigastric pain exacerbated by eating and relieved by rest. She endorsed constipation but denied any fever, nausea, vomiting, diarrhea, melena or hematochezia. Physical exam was notable for moderate generalized pain and guarding, but no rebound tenderness. CMP revealed normal transaminases, mildly elevated Alk Phos 146 and normal T Bili 0.3 Rest of CMP and CBC were otherwise unremarkable. CT Abd/Pelv w/contrast revealed masslike diverticulitis in the mid-transverse colon concerning for a mass. Given these findings, colonoscopy was pursued which revealed nodularity, necrosis, irregular margins, and scarring in the mid-transverse colon compatible with protrusion of surgical mesh into the colon. Biopsies of this site were obtained, and pathology results were negative for malignancy. Patient has since been referred to surgery. Discussion: The differential diagnosis for abdominal pain is too numerous to count, and in the setting of prior abdominal surgery the task of obtaining the correct diagnosis is made even more difficult. Perforation of surgical mesh through the mid-transverse colon is an extremely rare phenomenon and the index of suspicion for such a complication must be high. In our case, though physical exam and laboratory studies were vague and nonspecific, CT Abd/Pelv findings increased our urgency for colonoscopy which resulted in subsequent appropriate referral and management of the patient. Unfortunately, literature search for abdominal pain in the setting of mesh protrusion through the colon has been heterogenous and scarce. Thus, more research must be done in this area.Figure 1.: Nodularity, necrosis, irregular margins, and scarring in the mid-transverse colon compatible with protrusion of surgical mesh into the colon.