Fistules intestinales tardives après implantation de prothèse pariétale abdominale

Gas gangrene of the abdominal wall due to late-onset enteric fistula after polyester mesh repair of an incisional hernia

“…This serious complication is encountered in a period of 1 to 15 years after primary repair (6 years for our patient) [1][2][3][4][5] and its frequency varies between 0.3 and 3.5% [1,2]. The occurrence of this morbid condition may require iterative and complex operations, and may lead to death, as for our patient [1][2][3]. It is more likely to be encountered when mesh is intra-peritoneal, directly over the viscera, than when placed pre-peritoneal or retro-muscular [1][2][3][4].…”

“…The occurrence of this morbid condition may require iterative and complex operations, and may lead to death, as for our patient [1][2][3]. It is more likely to be encountered when mesh is intra-peritoneal, directly over the viscera, than when placed pre-peritoneal or retro-muscular [1][2][3][4].…”

“…Contributory factors have been identified, such as the kind of prosthesis (with higher rates of complication when a polyester mesh is used), the upper location of the hernia, the prosthetic repair of strangulated hernias, previous wound infection, the excision of hernia sac and the absence of omentum transposition between the prosthetic material and the intestine [1][2][3][4][5]. Many of these factors were included in this case report, such as the upper location of the incisional hernia and the use of a polyester intra-peritoneal mesh.…”

“…Late-onset enteric fistula can present as a chronic recurrent wound infection [1,2], an entero-cutaneous or colo-cutaneous fistula [1][2][3], an obstruction due to the migration of the material into the lumen of the digestive tract [2], a urinary infection when mesh migrates into the bladder [2] or an intra-peritoneal abscess secondary to an internal fistula [1,2]. In this case report, the extensive necrosis of the abdominal wall led to the patient's death by severe septicaemia.…”

“…It consists in resecting the affected intestinal segment and removing the mesh, which is not always possible [1][2][3][4]. However, the best Intra-operative view: the Mersilene plate was in contact with the intestinal loops, which are home to two holes pipelined by two probes treatment remains prevention by avoiding placing the synthetic material directly over the viscera [1][2][3][4][5]. Furthermore, composite meshes are available and may decrease the frequency of this complication, but they do not completely protect from late-onset fistulae [7].…”