J Korean Surg Soc.  2009 Feb;76(2):119-122. 10.4174/jkss.2009.76.2.119.

An Ileocutaneous Fistula That Developed 12 Years after Repair of an Abdominal Wall Defect Using Intraperitoneal Placement of High-density Polypropylene Mesh (Marlex(R))

• Hong WS
• Lee JM
• Chung H
• Kim TW
• Yang SK
• Kim HS
• Lee TU

• KMID: 2211271
• DOI: http://doi.org/10.4174/jkss.2009.76.2.119

Abstract

Although prosthetic materials are commonly used to repair abdominal wall defects, they are also associated with postoperative complications. These complications could be prevented by the adoption of uniform guidelines on surgical methods and materials, but the best anatomical position for placement of prosthetic meshes is unclear. We report a case of an enterocutaneous fistula that developed after an abdominal wall defect was repaired by intraperitoneal application of a prosthetic mesh (Marlex(R)) to raise awareness of the consequences of improper use of prosthetic materials.

Keyword

Surgical mesh; Intestinal fistula; Abdominal wall; Polypropylene

MeSH Terms

Abdominal Wall
Adoption
Fistula
Intestinal Fistula
Polypropylenes
Postoperative Complications
Surgical Mesh
Polypropylenes

Figure

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  Fig. 1 (A) Abdominal spiral computed tomography (CT). This study revealed tubular structure, which was suspiciously thought to be part of the bowel, was protruded through the defect on the midline between rectus abdominis muscles. This suspicious bowel and adjacent parietal peritoneum showed diffused wall thickening and prominent enhancement. (B) Enterocutaneous fistulogram with Gastrografin for the confirmation of fistula between abdominal skin and ileum. Contrast material was identified at small bowel, but there was no extravasation or collection of contrast material through the fistula tract.

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  Fig. 2 (A) Intraoperative findings of laparotomy for previously indwelt intraperitoneal prosthetic mesh removal. (B) Removed polypropylene prosthetic meshes. These showed grayish, tan, and irregular soft tissue appearances. The larger removed mesh measures 7.8×4.5 cm and the others measure similarly.

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  Fig. 3 Microscopic finding of the removed high-density polypropylene mesh. This is a plastic meshwork with foreign body reaction that contained inflamed granulation tissue and showed hemorrhagic and necrotizing inflammation (Hematoxylin-eosin stain, Magnification ×100).

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