{"title":"TEP 腹股沟疝修补术后表现为腹膜前脓肿和皮肤瘘的晚发网片感染:病例报告。","authors":"Angel Chao, Hao-Chien Hung","doi":"10.12659/AJCR.944843","DOIUrl":null,"url":null,"abstract":"<p><p>BACKGROUND Endoscopic inguinal hernia repair has become the preferred technique currently. The use of mesh to facilitate a tension-free reinforcement has become the standard of care during endoscopic totally extraperitoneal (TEP), laparoscopic transabdominal pre-peritoneal, and open inguinal hernia repair. Although uncommon, late-developing mesh infections, defined as those occurring in the surgical site months or years after the procedure, can lead to severe complications. To achieve the best possible outcome for the patient, prompt imaging and a multidisciplinary approach to management, including complete surgical removal of the contaminated mesh and proper antibiotic therapy, are crucial. CASE REPORT A 39-year-old woman presented with a 1-month history of intermittent fever, progressive lower abdominal pain and fullness, and purulent discharge from the abdominal wall. Her medical history was significant for an endoscopic right TEP inguinal hernia repair performed 3 years earlier, which involved the use of an anatomic mesh and titanium screws. Physical examination and ultrasound findings revealed a large preperitoneal abscess with cutaneous fistulization, secondary to a deep-seated mesh infection. Pseudomonas aeruginosa was identified as the causative pathogen. She underwent a 2-step surgical procedure, including an initial fistulectomy followed by endoscopic abscess drainage and surgical excision of the infected mesh, combined with antimicrobial therapy, resulting in an excellent clinical response and complete resolution. This strategy also allowed for an effective assessment of the abdominal wall integrity. CONCLUSIONS This case underscores the importance of considering late-developing mesh infections in patients presenting with abdominal symptoms who have previously undergone TEP hernia repair, even years after the initial surgery.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":null,"pages":null},"PeriodicalIF":1.0000,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299870/pdf/","citationCount":"0","resultStr":"{\"title\":\"Late-Onset Mesh Infection Manifesting as Preperitoneal Abscess and Cutaneous Fistula Post-TEP Inguinal Hernia Repair: A Case Report.\",\"authors\":\"Angel Chao, Hao-Chien Hung\",\"doi\":\"10.12659/AJCR.944843\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>BACKGROUND Endoscopic inguinal hernia repair has become the preferred technique currently. The use of mesh to facilitate a tension-free reinforcement has become the standard of care during endoscopic totally extraperitoneal (TEP), laparoscopic transabdominal pre-peritoneal, and open inguinal hernia repair. Although uncommon, late-developing mesh infections, defined as those occurring in the surgical site months or years after the procedure, can lead to severe complications. To achieve the best possible outcome for the patient, prompt imaging and a multidisciplinary approach to management, including complete surgical removal of the contaminated mesh and proper antibiotic therapy, are crucial. CASE REPORT A 39-year-old woman presented with a 1-month history of intermittent fever, progressive lower abdominal pain and fullness, and purulent discharge from the abdominal wall. Her medical history was significant for an endoscopic right TEP inguinal hernia repair performed 3 years earlier, which involved the use of an anatomic mesh and titanium screws. Physical examination and ultrasound findings revealed a large preperitoneal abscess with cutaneous fistulization, secondary to a deep-seated mesh infection. Pseudomonas aeruginosa was identified as the causative pathogen. She underwent a 2-step surgical procedure, including an initial fistulectomy followed by endoscopic abscess drainage and surgical excision of the infected mesh, combined with antimicrobial therapy, resulting in an excellent clinical response and complete resolution. This strategy also allowed for an effective assessment of the abdominal wall integrity. CONCLUSIONS This case underscores the importance of considering late-developing mesh infections in patients presenting with abdominal symptoms who have previously undergone TEP hernia repair, even years after the initial surgery.</p>\",\"PeriodicalId\":39064,\"journal\":{\"name\":\"American Journal of Case Reports\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.0000,\"publicationDate\":\"2024-07-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299870/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Case Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.12659/AJCR.944843\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.12659/AJCR.944843","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
背景 内窥镜腹股沟疝修补术已成为目前的首选技术。使用网片进行无张力加固已成为内窥镜腹膜外(TEP)、腹腔镜经腹腹膜前和开腹腹股沟疝修补术的标准护理方法。晚期网片感染(指手术后数月或数年发生在手术部位的感染)虽然并不常见,但可导致严重的并发症。为使患者获得最佳治疗效果,必须及时进行影像学检查并采取多学科方法进行治疗,包括通过手术彻底清除受污染的网片并采用适当的抗生素治疗。病例报告 一位 39 岁的女性患者因间歇性发热、进行性下腹痛和饱胀以及腹壁脓性分泌物就诊 1 个月。她的病史很重要,3 年前曾进行过一次内镜下右侧 TEP 腹股沟疝修补术,术中使用了解剖网片和钛螺钉。体格检查和超声检查结果显示,腹膜前大脓肿伴皮肤瘘管,继发于深层网片感染。铜绿假单胞菌被确定为致病病原体。她接受了两步手术治疗,包括最初的瘘管切除术,然后是内镜下脓肿引流和手术切除受感染的网片,并结合抗菌治疗,结果临床反应极佳,病情完全缓解。这一策略还能有效评估腹壁的完整性。结论:本病例强调,对于曾接受过 TEP 疝修补术并出现腹部症状的患者,即使是在初次手术后数年,也必须考虑网片感染的晚期发展。
Late-Onset Mesh Infection Manifesting as Preperitoneal Abscess and Cutaneous Fistula Post-TEP Inguinal Hernia Repair: A Case Report.
BACKGROUND Endoscopic inguinal hernia repair has become the preferred technique currently. The use of mesh to facilitate a tension-free reinforcement has become the standard of care during endoscopic totally extraperitoneal (TEP), laparoscopic transabdominal pre-peritoneal, and open inguinal hernia repair. Although uncommon, late-developing mesh infections, defined as those occurring in the surgical site months or years after the procedure, can lead to severe complications. To achieve the best possible outcome for the patient, prompt imaging and a multidisciplinary approach to management, including complete surgical removal of the contaminated mesh and proper antibiotic therapy, are crucial. CASE REPORT A 39-year-old woman presented with a 1-month history of intermittent fever, progressive lower abdominal pain and fullness, and purulent discharge from the abdominal wall. Her medical history was significant for an endoscopic right TEP inguinal hernia repair performed 3 years earlier, which involved the use of an anatomic mesh and titanium screws. Physical examination and ultrasound findings revealed a large preperitoneal abscess with cutaneous fistulization, secondary to a deep-seated mesh infection. Pseudomonas aeruginosa was identified as the causative pathogen. She underwent a 2-step surgical procedure, including an initial fistulectomy followed by endoscopic abscess drainage and surgical excision of the infected mesh, combined with antimicrobial therapy, resulting in an excellent clinical response and complete resolution. This strategy also allowed for an effective assessment of the abdominal wall integrity. CONCLUSIONS This case underscores the importance of considering late-developing mesh infections in patients presenting with abdominal symptoms who have previously undergone TEP hernia repair, even years after the initial surgery.
期刊介绍:
American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.