Gastrocutaneous fistula caused by mesh migration following diaphragmatic rupture repair

Abstract

Gastrocutaneous fistula caused by mesh migration following diaphragmatic rupture repair A 60-year-old female was involved in a traffic accident, presented with blunt thoracoabdominal trauma and admitted to our department in November 2018. Abdominal exploration revealed ruptured spleen and gastric herniation caused by left hemidiaphragm rupture. The burst spleen was surgically removed and the stomach was brought down into the abdomen. We noticed a radial defect about 10-cm-long in the posterolateral aspect of the left diaphragm which could not be repaired primarily. Thus, we decided to reinforce the repair using a synthetic mesh secured to the diaphragm circumferentially overlapping the margins with interrupted suture. However, the postoperative complication occurred after being symptom-free for 2 years. She returned to our department in June 2022 with complaints of yellowish discharge from the left upper abdomen wound.The patient's symptoms were self-limiting throughout the past year. There was no abdominal pain or detectable fever, and the wound outflow was maintained at a few millilitres per day. Abdominal CT showed that the mesh had migrated into the stomach and subcutaneous tissue. Gastrointestinal contrast revealed a fistulous tract extending from the stomach to the abdominal wall, which confirmed the presence of gastrocutaneous fistula (Fig. 1). Combined with the above symptoms and imaging examinations, we performed exploratory laparotomy and found dense adhesion between the stomach, diaphragm, and abdominal wall. Fortunately, the defect was not noted in the diaphragm. Finally, we confirmed that the mesh had moved from the stomach to the subcutaneous tissue during the procedure (Fig. 2), and the infected mesh was eliminated (Fig. 3). The fistula-forming anterior gastric wall was resected en bloc with the fistula. Subsequent gastrorrhaphy was created using the proximate linear cutter stapler. Primary fascial closure was used to fix the narrow ventral defect, and the laparotomy wound was closed in layers. The