Colocutaneous Fistula Due to Cecum Invasion with Mesh Plug After Inguinal Hernia Repair, Case Report and Literature Review

Abstract

Background: Inguinal hernia repair, among the most frequently performed surgical procedures worldwide, is generally associated with low morbidity. However, complications such as mesh migration and erosion into adjacent anatomical structures, although rare, can have significant clinical implications. Full-thickness erosion of mesh into the cecum, resulting in a colocutaneous fistula, represents an exceedingly rare phenomenon.

Case Presentation: This report details the case of an 82-year-old male with a prior history of right inguinal hernia repair who presented with persistent fecaloid discharge from the surgical scar following an initial episode of abscess formation and incision and drainage. Advanced imaging modalities identified an enterocutaneous fistula connecting the cecum to the inguinal region. Diagnostic laparoscopy revealed necrosis of a segment of the cecum caused by erosion of a polypropylene mesh plug. The patient underwent laparoscopic hemicolectomy with complete excision of the mesh and subsequent debridement and repair of the inguinal wound. Postoperatively, the patient experienced an uneventful recovery, and the surgical site healed successfully.

Conclusion: Clinicians should maintain a high index of suspicion for mesh-related complications, such as erosion and fistula formation, in patients presenting with delayed abscesses or intestinal discharge at prior hernia repair sites. This case underscores the importance of careful patient selection and consideration of alternative techniques in high-risk individuals to minimize the incidence of such rare but serious outcomes.