Infected inguinal hernia mesh presenting as pseudotumor of the bladder
A 53-year-old male presented to the surgical department with lower abdominal pain. An ultrasound revealed a well-defined 5.6 × 4.6 cm isoechoic lesion superior to the urinary bladder and connecting with the umbilicus via a duct, suggesting an urachal remnant lesion or an infected urachal cyst. Subsequently, he was referred to our urology department for further management.\nHe was diabetic and had undergone a laparoscopic inguinal hernia mesh repair 2 years previously. Physical examination revealed some abdominal tenderness. Urine sediment and culture showed no abnormalities, laboratory findings were normal and abdominal computed tomography (CT) scan confirmed a urachal cyst []. Preoperative cystoscopy showed normal bladder mucosa. The patient deferred intervention for 9 months for personal reasons. On laparotomy, a 10-12 cm fibrous nodular mass was seen arising from the dome of the urinary bladder, fixed to the right posterior surface of the rectus muscles. Because the procedure was performed late at night, no pathologist was available so frozen section could not be done. Because of its malignant appearance, we considered the risk of invasion and metastasis very likely, what resulted in discontinuation of the procedure. Incisional biopsy was taken and procedure was deferred until histopathological examination was done. Because the preoperative CT scan had become dated, we repeated an abdominal CT scan postoperative, which showed a lesion with heterogeneous solid components and thickening of anterior bladder wall []. Histopathological examination revealed fibroinflammatory tissue.\nRuled out malignant disease, 6 days after the initial procedure relaparotomy with frozen section was planned. During dissection, the tumor was identified infiltrating the posterior wall of the right rectus sheath. Frozen section was done to exclude a sampling error and to rule out an inadequate first sample. Further dissection revealed presence of the previously placed inguinal mesh []. Excision of ventral part of the bladder wall, total fibrous tissue, and mesh was performed and frozen section was suggestive of inflammatory pseudotumor. Histopathological examination confirmed the frozen section, without any signs of malignancy []. The postoperative period was uncomplicated and patient was discharged asymptomatically after 3 days.