Erosion of small intestine with necrotising fasciitis of over lying abdominal wall after expanded poly-tetrafluoroethylene mesh implantation: A rare complication after laparoscopic incisional hernia repair
A 45-year-old lady was admitted to the hospital with 2-day history of pain in abdomen and vomiting. Six years prior to admission, the patient had a caesarean section delivery. She subsequently developed an incisional hernia and underwent a LIHR by an experienced laparoscopic surgeon 6 weeks before. An ePTFE mesh was placed intraperitoneally and fixed with tackers and trans-abdominal polypropylene sutures. Patient was alright for up to 1 month till she started developing vomiting on and off. She was conscious, oriented. Pulse rate was 120/min and blood pressure was 50mm Hg (systolic). There were added sounds on chest auscultation and on abdominal examination, there was mild distension, tenderness, rigidity, guarding and a 7cm fluctuant swelling in right lumbar quadrant with blackish discoloration of overlying skin (the hernia site). Haematological values were Hb, 7.5 g/dl; Total Leucocyte Count, 5,840 cells/cmm; serum biochemical values showed as blood glucose (R), 66 mg/dl;serum creatinine, 1.4 mg/dl; serum albumin, 1.3 g/dl; serum sodium, 142.6 meq/l; and serum potassium, 3.1 meq/l. Ultrasonography abdomen showed: loculated collection in pelvis (~60cc), parietal wall collection (~100cc) in right lower abdomen at the site of previous surgical site communicating with peritoneal cavity and associated scar dehiscence; X-ray chest poster o anterior view showed: patchy-confluent consolidation in bilateral lung fields.\nPatient was admitted in intensive care unit (ICU). Intravenous fluids and inotropic drugs were given and eventually ventilatory support was given for difficulty in respiration and falling arterial oxygen saturation. On all life supports, patient was operated. Intraoperative findings were: necrotising fasciitis of overlying abdominal wall, infected mesh densely adhered to gut, feculent fluid, dense cohesive adhesions and two nearby small bowel perforations [Figures and ]. Liberal debridement of overlying anterior abdominal wall, maximum resection of implanted mesh, small bowel segmental resection and exteriorisation of bowel ends were done. Unfortunately, patient went into multiorgan dysfunction syndrome and expired on post-operative day 3.