S1817 Rare and Unexpected Finding on Colonoscopy for Abdominal Pain

Abstract

INTRODUCTION: Incisional hernias are a common complication of abdominal surgeries with an incidence of approximately 10 to 15%. Polypropylene mesh is commonly used to repair these hernias and is effective in decreasing their recurrence. Infection, pain, and adhesions are common complications associated with hernia repair that occur early in the post-operative period. Mesh migration and erosion into adjacent organs have been rarely reported and can present with symptoms at any time after hernia repair. We present a case of migration and erosion of a hernia mesh into the colon approximately nine years after incisional hernia repair. CASE DESCRIPTION/METHODS: The patient was a 70-year-old male who underwent colonoscopy for abdominal pain. Nine years prior to this, patient had recurrent sigmoid colon diverticulitis and perforation, for which he had undergone sigmoid colon resection and Hartman's pouch with a subsequent takedown of colostomy. At the time of colostomy reversal, patient also underwent repair of an incisional hernia with placement of a polypropylene mesh. A few weeks prior to the current colonoscopy, he had developed acute left lower quadrant abdominal pain and CT scan showed thickening of the descending colon (Image 1) which was initially treated conservatively. At colonoscopy, a metal mesh was seen embedded eccentrically in the colon wall about 25 cm from the anal verge with thickening of surrounding colonic mucosa (Image 2) for which he was referred to surgery. At subsequent exploratory laparotomy, the mesh had migrated and was adherent to the pelvic side wall, extending and eroding into the adjacent colon wall. The mesh was removed, and a left hemicolectomy with an end colostomy was performed. Patient has been doing well six months following surgery with plans for abdominal wall reconstruction. DISCUSSION: Hernia repair with mesh is an effective procedure that decreases the risk of recurrence significantly and is generally tolerated well. Very rarely mesh can migrate and erode into adjacent organs. Its clinical presentation is variable and is generally related to the organ involved. Pain in the area of migration is the most common presenting symptom. Migration occurs gradually over several years. Given the frequency with which these surgical procedures are performed, this complication is extremely rare and can be missed easily. Gastroenterologists should thus be aware of this potential complication and appropriately refer these patients to our surgical colleagues.Figure 1.: Thickening of the descending colon seen on CT Scan.Figure 2.: Mesh eroding into the colon wall eccentrically seen on colonoscopy.