Shoenfeld syndrome or Autoimmune/Inflammatory Syndrome Induced by Adjuvants syndrome: a case of inguinal hernia mesh rejection after 9 years.

Abstract

Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA Syndrome), also called Schoenfeld syndrome, is a rare inflammatory reaction to implant materials. We report a case of mesh rejection nine years after left inguinal hernia repair in a 62-year-old man presenting with intense localized pain and inflammatory signs, including psoasitis. Imaging revealed sepsis with an inguinal collection extending to the ipsilateral iliopsoas and sartorius muscles. The patient underwent surgical mesh removal and drainage; tissue samples showed aseptic fluid collections without pathogens. Postoperatively, the patient received four sessions of hyperbaric oxygen therapy alongside radiological drainage of a residual collection in the lower limb. Literature on inflammatory responses to mesh rejection remains scarce, with ASIA Syndrome potentially triggered by any implant and with uncertain prognosis. Delayed mesh rejection is a notable complication of hernia repair, warranting patient awareness. Treatment includes mesh extraction, inflammation control, drainage, and hyperbaric therapy, though management guidelines remain undefined.