Perforation of the sigmoid colon as a late complication after open inguinal mesh repair

Background: Since many years we favor a preperitoneal approach for the insertion of prosthetic material in
the treatment of inguinal hernias. Open and laparoscopic techniques are performed for primary
and recurrent hernias. Although late intra-abdominal complications after hernioplasty are seldom
encountered, it should be a part of surgeon’s differential diagnostic algorhythm.
Case report: This case report describes a 61-year-old female patient who developed a perforation of the sigmoid
colon many years after anterior inguinal mesh repair. The surgical management is described as
well as the possible mechanism responsible for this devastating complication.
Conclusions: Abdominal wall surgeons should be aware of this kind of late complication following preperitoneal
inguinal mesh repair. Care should be taken at the time of dissection and peritoneal closure to
prevent any risk of residual defect. Surgical management should consist of resection of the
diseased bowel and complete removal of the foreign body. In case fragments of the mesh are
left behind, they must be covered with a peritoneal flap or omental tissue. Oxidized regenerated
cellulose (Surgicel[sup]R[/sup]) can be an alternative.

Keywords: inguinal hernia, hernioplasty, mesh migration, sigmoid perforation