Small bowel ischemia caused by wrapping of the appendix around the small bowel after adhering to eroded mesh following elective laparoscopic TAPP repair.

Abstract

Laparoscopic transabdominal preperitoneal (TAPP) repair is the gold standard for treatment of inguinal hernia. Its complications are well known; however, its rare complications, such as mesh erosion and migration are commonly overlooked. There is established evidence about mesh complications; however, we have not found a similar case to what we encountered. We present a case of an elderly male who presented with a closed-loop bowel obstruction following a TAPP repair. Intraoperatively, the appendix tip was adherent to the eroded mesh through a defect in the peritoneal flap. The appendix formed a constricting wrap around the terminal ileum with a resultant ischemia of the bowel in the presence of a competent ileocecal valve. Reasons accounting to mesh erosion can be divided into primary and secondary causes. Complications from mesh erosion vary from fistulation up to bowel ischemia. Failure to recognize these complications can lead to considerable morbidity.