We report the case of a 41-year-old male who underwent repair of a recurrent midline abdominal incisional hernia with components separation. The hernia defect was repaired with a 30 cm × 30 cm underlay biological (Strattice) mesh used to partially bridge a small residual gap between the rectus muscles and reinforced with a 30 cm × 30 cm lightweight polypropylene onlay mesh (BARD™ soft mesh). The patient later developed a large persistent seroma that was excised 18 weeks later. On exploration of the previous hernia repair, it was noted that the onlay polypropylene mesh had fractured leaving a 3 cm by 2 cm defect, but the underlying biological mesh was intact preventing a recurrence of the hernia (see Fig. 1). The fractured mesh was repaired with an additional onlay 10 cm × 10 cm polypropylene mesh, the seroma was de-roofed, and the patient was later discharged. This case highlights the early mechanical failure of a lightweight polypropylene mesh; the precise mechanism of failure in this case is unclear and, however, may be related to high intra-abdominal pressures postoperatively. Fig. 1 Photograph showing onlay polypropylene (BARD™ soft mesh) mesh superficial to a biological (Strattice) sublay mesh bridging the recti (on the left and right wound edges). Arrow indicates the 2 cm by 3 cm fracture.
We report the case of a 78-year-old female who was found to have a mycotic thoracic aortic arch aneurysm caused by Clostridium septicum. Subsequent investigations demonstrated adenocarcinoma of the caecum with two liver metastases. The patient underwent a hybrid procedure involving endovascular repair of the aneurysm with a right-to-left carotid crossover bypass and a left carotid to left subclavian bypass to protect the cerebral and left subclavian blood flow. The caecal tumour was later completely excised by laparoscopic right hemicolectomy. The patient then underwent resection for the liver metastases. There was no evidence of tumour recurrence 2 years after her right hemicolectomy. This case emphasizes the importance of the association of C. septicum infection with colorectal malignancy. To our knowledge, this is the first case of a mycotic aortic arch aneurysm caused by C. septicum being successfully treated with a hybrid endovascular repair procedure.
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