Colocutaneous fistula due to polypropylene mesh

Lobato, R Fernández; Santos, C Martínez; Ortega‐Deballon, Pablo; López, José María Rodríguez; Lucas, Francisco Javier; Azcoita, M Moreno

doi:10.1007/s100290100003

Cited by 36 publications

(8 citation statements)

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“…The use of mesh in parastomal hernia repair is associated with development of adhesions, bowel obstruction, wound infection, and development of enterocutaneous fistulae in 2 to 8% of the patients. 36,37 Composite mesh prosthetics composed of both polypropylene/polyester and ePTFE have been designed specifically for use in parastomal hernias in an effort to mini-mize these complications. The risk of parastomal hernia recurrence following repair with synthetic mesh is reported to be 16.7% with a mesh infection rate of 3%.…”

Section: Choice Of Prosthetic Materialsmentioning

confidence: 99%

Stoma Complications

Krishnamurty

Blatnik

Mutch

2017

Clinics in Colon and Rectal Surgery

147

157

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).Roughly 150,000 stomas are created in the United States annually, equally divided between ileostomies and colostomies.1 When created properly, an ileostomy or colostomy can dramatically improve a patient's quality of life. Patients with a good functioning stoma can expect to live a normal life with very few lifestyle restrictions. In contrast, when a patient develops complications related to their stoma, the impact on their physical and mental health can be irreparable. Stomas can be created for a multitude of diseases such as colorectal cancer, ulcerative colitis, Crohn's disease, diverticulitis, ischemic colitis, radiation injury, and fecal incontinence. The associated morbidity and overall function of a stoma are dependent upon the indication for the stoma, whether it was created electively or emergently, and patient factors such as body habitus and prior surgery. Unfortunately, significant morbidity is associated with stoma creation and these complications can be grouped into early and late-occurring complications. The literature reports the rate of stoma-related complications ranging from 20 to 70%.2-7 Early complications occur within the first 30 days of the stoma creation and include ischemia/necrosis, retraction, mucocutaneous separation, and parastomal abscess. Late complications include parastomal hernia, prolapse, retraction, and varices. All of these complications will be discussed to better understand etiologies and management options. Risk Factors for Stoma-Related ComplicationsAs mentioned previously, stoma creation carries significant morbidity, and disease, patient, clinical, and stoma-specific factors influence the outcomes pertaining to their creation. Harris et al found the most common stoma-related complications in 345 ostomates were herniation, retraction, necrosis, infection, prolapse, stenosis, fistula, and small bowel obstruction (SBO). 4 Complications were more common with colostomies except for SBO, which were more prevalent with ileostomies. The authors also found that loop colostomies had the highest complication rate out of all stoma configurations. Postoperative stoma necrosis was strongly and significantly associated with emergency stoma creation. Parmar et al identified that colostomies, short stoma length, body mass index > 30, emergency surgery, and lack of preoperative marking were associated with increased risks of complications. 7 None of the identified studies was adequately powered to stratify postoperative stoma-related complication rates by specific disease processes. Parastomal HerniaParastomal hernias are incisional hernias at ostomy sites and are believed to be an inevitable consequence of having an Keywords ► parastomal hernia ► stoma prolapse ► colostomy ► ileostomy ► parastomal varices AbstractWhen created properly, an ileostomy or colostomy can dramatically improve a patient's quality of life. Conversely, when a patient develops complications related to their stoma, the impact on physical and mental health can be profound. Unfortunately, significant morbidity is...

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Section: Choice Of Prosthetic Materialsmentioning

confidence: 99%

Stoma Complications

Krishnamurty

Blatnik

Mutch

2017

Clinics in Colon and Rectal Surgery

147

157

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“…10 We found just one comparative study about early and late-onset prosthetic mesh infection published in 2015 by Wengcheng Kong et al 11 Very few case reports or research articles were found on ECF following open incisional hernia repair. [12][13][14] For prevention of fistulas, Losanoff et al proposed using tissue impervious composite material in close proximity of bowel. 15 It is of general consensus now that composite barrier meshes or strand coated meshes should be used intraperitoneally or in close proximity to bowel in order to minimise adhesions.…”

Section: Discussionmentioning

confidence: 99%

Enterocutaneous fistula secondary to mesh erosion of bowel: a late complication of polypropylene mesh use in ventral hernia repair

Saxena

Saini²

2019

Int Surg J

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Use of mesh for reinforcing hernia defects has become standard procedure but it is associated with a few serious complications like bowel erosion and fistula formation. We present a case of a 62 yrs lady with enterocutaneous fistula due to mesh erosion of small bowel, 10 yrs after open incisional hernia repair using polypropylene mesh who had to undergo laparotomy and resection of eroded bowel. A brief review of literature revealed that very few case reports of such fistulas following open incional hernioplasty have been reported and that current research on improving the properties of mesh may reduce such complications in future.

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“…It has been reported that the incidence of enterocutaneous fistula, due to prosthetic mesh, is higher, when placed in the subfacial versus the onlay position (5.2 % versus 2.6 %, respectively) [ 11 ]. There are several reasons why a prosthetic mesh can fistulise into a hollow viscus.…”

Section: Discussionmentioning

confidence: 99%

Sigmoid to scrotal fistula secondary to mesh erosion: a rare complication of inguinal hernia repair in a patient on anticoagulation

et al. 2015

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BackgroundFew reports from the medical literature have presented severe mesh-related complications following laparoscopic repair of inguinal hernia. One of these complications is being mesh erosion into bowel, resulting in fistulous tract with subsequent abscess formation.Case presentationA 75-year-old patient, status post laparoscopic bilateral inguinal hernia repair, and on anticoagulation for dual prosthetic heart valves, presented with a unique case of sigmoid to scrotal fistula, post mesh erosion, resulting in sepsis. The patient presented in septic shock, necessitating an individualized surgical approach. Given the septic picture of our patient, the surgical approach was truncated. Initially the sepsis from the scrotum was drained and debrided. A watermelon seed was noted in the scrotum. After stabilization, the second stage approach was performed, were a laparotomy was performed, followed by division of the sigmoid to internal ring fistula, and reperitonealization of the mesh. Mesh removal was delayed as the risk of bleeding into the peritoneum was high, once anticoagulation needed to be resumed. Because of a persistent wound sinus tract, several months later, the mesh was removed, in a third stage, from an inguinal incision. Albeit meticulous dissection and homeostasis, a postoperative extraperitoneal inguinal hematoma developed, as expected, on day 2, once anticoagulation was resumed.ConclusionSigmoid to inguinoscrotal fistula is a rare, yet serious, complication of mesh infection and erosion. This can be obviated by preventing serosal tear, and proper peritonealization of the mesh. Fistulectomy alone with primary repair turned out to be a valid approach in our patient. Retaining the mesh could be an alternative for avoiding bleeding in patients on anticoagulation; despite that a persistent indolent infection and sinus tract will necessitate mesh removal afterwards.

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Colocutaneous fistula due to polypropylene mesh

Cited by 36 publications

References 0 publications

Stoma Complications

Stoma Complications

Enterocutaneous fistula secondary to mesh erosion of bowel: a late complication of polypropylene mesh use in ventral hernia repair

Sigmoid to scrotal fistula secondary to mesh erosion: a rare complication of inguinal hernia repair in a patient on anticoagulation

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