Alshamali Mohammed, Sallam Sana, Alzaid Dhari, Abdulraheem Joud, Mohammad Khaleel
Department of Surgery, Al-Adan Hospital, Ministry of Health, Kuwait.
Int J Surg Case Rep. 2020;67:123-126. doi: 10.1016/j.ijscr.2020.02.004. Epub 2020 Feb 6.
Ventral hernia repair is a common surgical procedure performed within the specialty of general surgery. Short and long term complications can arise after this procedure. Although rare, an enterocutaneous fistula may occur, leading to a significant morbidity and the possible need for surgical intervention.
We present a rare case of a 76 years old female, who presented with the sudden occurrence of an enterocutaneous fistula arising ten years after a primary umbilical hernia repair with placement of a polypropylene onlay mesh. She was also found to have a large recurrent umbilical hernia. She underwent a laparotomy with the identification of a mesh eroding into the small bowel lumen, causing an enterocutaneous fistula. An enterectomy was performed to remove the fistula with the mesh, and a small bowel anastomosis was created.
Ventral hernia recurrence is associated with risk factors including old age, obesity, wound infection as well as the type and location of the mesh used. As in this case, enterocutaneous fistula after hernia repair can occur due to multiple factors including mesh migration and erosion into near-by structures including bowel. These risk factors can perhaps be modified to possibly reduce the incidence of complications like an enterocutaneous fistula.
The case highlights a rare but serious complication associated with a ventral hernia repair. It also addresses key aspects with regards to the possible mechanisms involved in the occurrence of an enterocutaneous fistula following a hernia repair with the use of a synthetic mesh.
腹疝修补术是普通外科专业中常见的外科手术。该手术后可能会出现短期和长期并发症。虽然罕见，但可能会发生肠皮肤瘘，导致严重的发病率，并可能需要手术干预。
我们报告一例罕见病例，一名76岁女性，在初次脐疝修补并放置聚丙烯补片后十年突然出现肠皮肤瘘。还发现她有一个巨大的复发性脐疝。她接受了剖腹手术，术中发现补片侵蚀小肠腔，导致肠皮肤瘘。进行了肠切除术以切除带有补片的瘘管，并进行了小肠吻合术。
腹疝复发与多种风险因素相关，包括老年、肥胖、伤口感染以及所用补片的类型和位置。如本病例所示，疝修补术后肠皮肤瘘可能由多种因素引起，包括补片移位和侵蚀附近结构（如肠管）。或许可以对这些风险因素进行调整，以可能降低诸如肠皮肤瘘等并发症的发生率。
该病例突出了腹疝修补术相关的一种罕见但严重的并发症。它还探讨了使用合成补片进行疝修补术后发生肠皮肤瘘的可能机制的关键方面。
