P-061 Bowel obstruction due to intraluminal migration of intraperitoneal mesh

Abstract

Aim Report an unusual late complication after laparoscopic IPOM Material & Methods Description of a clinical case Results An 84 years old patient who had previously undergone laparoscopic IPOM with ePTFE mesh in 2012 for supraumbilical primary hernia, arrived to the emergency room in March 2022 with a small bowel obstruction due to an intraluminal foreign body impacted at the distal jejunum. In the computerized tomography scan (CT) there was no evidence in the abdominal wall of the intraperitoneal mesh present in a previous CT from 2019. An exploratory laparotomy was warranted. A resection the affected jejunal loops was performed, without evident perforation and clear palpation of an intraluminal foreign body. When the piece was opened, the mesh was found intraluminally, causing the patient's bowel obstruction. Conclusions Intra-abdominal foreign bodies usually cause a chronic inflammatory process that isolate them from neighboring structures by a fibrous capsule. In this case, however, after detaching it from the abdominal wall, the mesh migrated into the intestinal lumen, probably through slow erosion by decubitus. Despite it being an unusual complication, its incidence could increase as the use of intra-abdominal mesh has multiplied in recent years. Given the appearance of non-specific abdominal pain in patients with intra-abdominal mesh, it may be advisable to perform a CT scan to rule out this or other complications associated with the mesh, even many years after the initial surgery.