Discitis due to late-onset mesh infection 14 years after inguinal hernia repair: a case report

Chiyo Maeda; Kai Kato; Saki Yamada; Mariko Tanaka; Ken Sujishi; Ryohei Sato; Shuichiro Takanashi; Masahiro Waseda; Tetsutaro Suzuki; Yasuo Ishida; Fumiko Kasahara

doi:10.1186/s40792-022-01449-y

Discitis due to late-onset mesh infection 14 years after inguinal hernia repair: a case report

Surg Case Rep. 2022 May 25;8(1):102. doi: 10.1186/s40792-022-01449-y.

Authors

Affiliations

¹ Digestive Surgery, Yokohama Asahi Chuo General Hospital, 4-20-1, Wakabadai, Asahi-ku, Yokohama, 241-0801, Japan. maechiyo@hotmail.co.jp.
² Digestive Surgery, Yokohama Asahi Chuo General Hospital, 4-20-1, Wakabadai, Asahi-ku, Yokohama, 241-0801, Japan.

Abstract

Background: Mesh infection after inguinal hernia repair is a very rare complication. The incidence of late-onset mesh infection is approximately 0.1-0.2% of total hernia repair cases and can lead to serious complications if not treated promptly. Here, we report a rare case of discitis due to late-onset mesh infection, occurring 14 years after an inguinal hernia repair.

Case presentation: An 89-year-old man was brought to our hospital with right-sided abdominal pain and signs of hypoglycemia. He had a history of type 2 diabetes mellitus and had undergone inguinal hernia repair 14 years ago. Upon admission, laboratory tests revealed no elevated inflammatory markers. Computed tomography (CT) revealed a peri-appendicular abscess. Although the patient was administered empiric antibiotics, on day 3 of admission, his white blood cell count and C-reactive protein levels increased to 38,000/µl and 28 mg/dl, respectively. CT-guided drainage was attempted but was not successful. Escherichia coli was detected in both blood culture collections. On day 7 of admission, the patient complained of back pain; CT on day 10 revealed a peri-appendicular abscess with a soft tissue shadow anterior to the thoracic vertebrae at the 8th/9th level. Thoracic discitis, due to bacteremia originating from the mesh abscess, was suspected. We surgically resected the appendix, followed by removal of the plug and mesh abscess. The post-operative course of the patient was uneventful. For treating discitis, it is known that antibiotic therapy is required for a minimum of 6 weeks. Therefore, on the 30th day post-surgery, the patient was transferred to the orthopedic ward for continued treatment.

Conclusions: This report discusses a rare case of late-onset mesh infection leading to thoracic discitis. Since late-onset mesh infection cannot be treated solely with antibiotics, expeditious surgery should be selected when subcutaneous drainage fails. When an immunocompromised patient with bacteremia has a complaint of back pain, purulent spinal discitis should also be suspected.

Keywords: Bacteremia; Fistula; Plug mesh.