Mesh erosion after laparoscopic posterior rectopexy: A rare complication
A 40-year-old man presented with occasional bleeding per rectum since 10 months with low grade intermittent fever for 1 week. He had history of LPMR for complete rectal prolapse 2 years back, carried out elsewhere. His abdominal and per rectal examinations were unremarkable. Sigmoidoscopy revealed hyperemic mucosa with ulceration 15 cm from anal verge, with a part of the polypropylene mesh projecting into the rectum []. Computed tomography (CT) scan of abdomen showed asymmetric anterior wall thickening of rectosigmoid junction with fat stranding and minimal fluid collection. Review of his surgical notes revealed that a 15 cm × 10 cm polypropylene mesh was used for rectopexy. Since it was a large mesh fixed with multiple tacks and possible dense adhesions, transanal approach was not attempted. Under general anesthesia, in lithotomy position, diagnostic laparoscopy was done. There were multiple dense adhesions in the pelvis. After sharp adhesiolysis, folded, and densely adherent polypropylene mesh was identified. Appendix was inflamed with its tip densely adherent to the mesh []. Excision of the mesh with appendectomy was done. There was a small rectal perforation at the site of erosion, which was confirmed by air leak test. Tube drain was kept into pelvis and diverting ileostomy was performed. He had an uneventful recovery with the ileostomy functioning from 2nd day. Patient was discharged with the drain on the 4th day. The drain was removed after 2 weeks. Distal loopogram was carried out after 3 months, which showed no leak. Subsequently ileostomy closure was done.