Koliakos Nikolaos, Tzortzis Andrianos-Serafeim, Papakonstantinou Dimitrios, Bakopoulos Anargyros, Pararas Nikolaos, Misiakos Evangelos, Pikoulis Emmanouil
Department of Abdominal Surgery, Erasme Hospital, Free University of Brussels (ULB), Brussels, BEL.
Department of Ear, Nose & Throat (ENT), Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, GBR.
Cureus. 2024 May 7;16(5):e59842. doi: 10.7759/cureus.59842. eCollection 2024 May.
Mesh placement remains the standard of care for inguinal hernioplasty, whether through the classic open approach or the transabdominal preperitoneal (TAPP) approach. Though both techniques are generally safe, they can occasionally result in visceral injuries, albeit infrequently. Mesh migration into the intestines is a morbid situation requiring emergency treatment. We present two male patients who developed mesh-enterocutaneous fistula several years after inguinal hernia repair. The first patient with a history of a bilateral TAPP hernia repair was admitted to the emergency department and underwent bilateral complete mesh removal, limited right colectomy, and wedge resection of the sigmoid colon, due to mesh erosion. The second patient, with a history of a left inguinal hernia treated by open mesh repair, presented to the emergency department complaining of intense pain in his left inguinal area. Erosion of the prosthetic mesh into the sigmoid and a colo-cutaneous fistula was identified, with sigmoidectomy and en bloc excision of the adherent mesh and end-colostomy being performed. Mesh erosion into the intestinal tract is a rare but serious condition. In patients presenting with a subcutaneous abscess in the inguinal region, clinicians should maintain a high level of suspicion for intrabdominal inflammation arising from mesh erosion into adjacent viscera. Surgical management becomes necessary in symptomatic cases or instances of fistulization.
无论采用经典开放手术还是经腹腹膜前（TAPP）手术，放置补片仍然是腹股沟疝修补术的标准治疗方法。虽然这两种技术总体上是安全的，但偶尔也会导致内脏损伤，尽管这种情况很少见。补片迁移至肠道是一种需要紧急治疗的严重情况。我们报告了两名男性患者，他们在腹股沟疝修补术后数年出现了补片-肠皮肤瘘。首例患者有双侧TAPP疝修补病史，因补片侵蚀，被收入急诊科，接受了双侧补片完全取出、右半结肠有限切除术和乙状结肠楔形切除术。第二例患者有左侧腹股沟疝开放补片修补病史，因左侧腹股沟区剧痛就诊于急诊科。发现人工补片侵蚀至乙状结肠并形成结肠皮肤瘘，遂行乙状结肠切除术、粘连补片整块切除及结肠造口术。补片侵蚀肠道是一种罕见但严重的情况。对于腹股沟区出现皮下脓肿的患者，临床医生应高度怀疑补片侵蚀相邻脏器引起的腹腔内炎症。对于有症状的病例或出现瘘管的情况，手术治疗是必要的。
