Small Bowel Obstruction From Ventral Hernia Mesh Eroding into the Bowel and Turning into a Bezoar

Abstract

Intro: As hernia operations become more common, so do their complications which include infection, chronic pain, fistula formation, and adhesion formation to bowels. Ventral hernia repair can be performed using pre-peritoneal or intra-peritoneal methods. A disadvantage of the intra-peritoneal method is adhesions and irritations from the contact of the mesh with the bowel leading to higher incidence of visceral and vascular injuries. Most cases of erosion are reported in the literature to involve the urinary bladder and the vaginal cavity. Mesh migration is an infrequent occurrence. There are reports of mesh migrating into viscous organs causing a variety of symptoms including a recurrent hernia, infection, and obstruction. Case Presentation: A 65-year-old man with the history of ventral hernia repair using polypropylene mesh in the past, and no other medical history presented to the hospital with nausea, vomiting, and abdominal pain. He had not passed flatus or had a bowel movement in 3 days and had experienced abdominal distension. Prior to this presentation, the patient had intermittent chronic abdominal pain, with nausea and vomiting for many years following his operation. In the exam, the patient was with a distended abdomen. His CT Abdomen /pelvis showed small bowel obstruction from what was initially thought to be ectopic gallstone. However, the patient had a gallbladder of 3mm on CT and no Air in the biliary tree. General surgery was consulted and patient was taken to the operating room where intraluminal mass obstructing the distal ileum was extracted. Intraoperatively small bowel was adhered to the site of the previous hernia operation. After extensive washout of the bezoar, a polypropylene mesh was extracted from the Bezoar.Discussion: Mesh erosion and migration into the intestine, although very rare, is a possible late complication of intraperitoneal hernia repair. At first glance this presentation may appear similar to gallstone ileus with the diagnostic criteria of SBO, ectopic gallstone of either rim-calcified or total-calcified, and abnormal gallbladder, however in this patient lack of air in biliary tree hints at lack of Cholecystduodenal fistula or cholecystcolonic fistula in this patient and we must look for other causes of SBO.2553_A Figure 1. Bezour found in CT imaging at transition point of SBO2553_B Figure 2. Polypropelene Mesh Extracted from The Bezoar