PMC6880573_01
a There is a small free fluid area noted between the bowel loops with possible small localized fluid collection seen posterior to the mesh and anterior to the cecum. b Suspicion 1 mm focal defect within the anterior cecal wall
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Fig1
Tomography (CT) scan of the abdomen and pelvis was done which showed diffuse wall thickening of the cecum and terminal ileum with abnormal configuration of the cecum and ill definition of its anterior wall with small free air worrisome for perforation (Fig. 1a & b). The decision was made in the ER to discharge him home on antibiotics.
Colonoscopy picture showing small solid structure found in the cecum
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Fig2
CT scan was ordered again and showed the same findings. Colonoscopy was ordered which showed small polyp that was removed and revealed benign adenoma, also showed a small solid structure in the cecum (Fig. 2).
The colonoscopy picture showing polypoidal mass
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Fig3
The colonoscopy showed a polypoidal mass that was biopsied and showed granulating tissues (Fig. 3).
A mesh graft is noted at the level of the cecum and medial to that a dense opacity of about 7.7 x 6.7 x 4 cm noted, which is medially of low attenuation and contains some air bubbles. (Inflammatory process or infectious process at the level of the cecum medial to the mesh)
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Fig4
CT scan of abdomen and pelvis was repeated which demonstrated opacity at the level of the cecum with dense opacity medial to it of low attenuation and contains some air bubbles (Fig. 4).
A colonoscopy showing a small mass in the cecum
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Fig5
Another colonoscopy was done which showed a small mass in the cecum (Fig. 5) that was biopsied and revealed to be granulating tissues, the patient was referred to the primary surgeon who reassured the patient and gave him a follow up appointment in one-year time.
a A foreign object that has migrated into the colon. b recurrence of a hernia shown. c thickening of the medial wall of the cecum with mesh graft material and extension of the mesh graft material through the cecal wall
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Fig6
A CT Colonography was ordered which showed a foreign object in the colon, possibly caused bleeding per rectum where the patient was referred back to the surgeon (Fig. 6a). A CT scan revealed recurrence of a periumbilical hernia and thickening of the medial wall of the cecum with mesh graft material that could suggest a complication of the previous ventral hernia repair with extension of the mesh graft through the cecal wall (Fig. 6b & c).
Intraoperative pictures during dissection of mesh adhesions to small bowel and colon
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Fig7
Skin closure completed with skin clips (Figs. 7, 8 & 9).
Small bowel and colon adhesion to mesh graft
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Fig8
Skin closure completed with skin clips (Figs. 7, 8 & 9).
Specimen removed of distal ileum, cecum and proximal part of ascending colon with part of the mesh graft adhesed to the distal ileum bowel and the other part of the mesh graft migrated inside the cecum
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Fig9
Skin closure completed with skin clips (Figs. 7, 8 & 9).