A Case of Abdominal Wall Abscess due to Perforated Appendicitis with Mesh Plug after Surgery for Inguinal Hernia

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 78; no. 3; pp. 536 - 541
• Main Authors: KOTERAZAWA, Yasufumi, KINUGASA, Shoichi, MONMA, Hiroyuki, HORI, Hiroshige, KISHI, Shinji, NAKAMURA, Takeshi
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2017
• Subjects: appendicitis; laparoscopy; mesh plug
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.78.536

A 68-year-old man, who had undergone a right inguinal hernioplasty for bilateral inguinal hernias 15 years previously, presented to our hospital in April 2016 because of right lower abdominal pain and inflammation in the right inguinal region. An abdominal CT scan showed abdominal wall abscess and swollen appendix. Emergent laparoscopy was performed with suspicions of acute appendicitis and strangulation due to recurrent right inguinal hernia. Exploratory laparoscopy revealed that the appendix firmly adhered to the mesh plug and penetrated into the right lower abdominal wall through it. We performed laparoscopic appendectomy and removal of the mesh as much as possible. The abdominal wall abscess was treated with percutaneous drainage through the inguinal region. The patient has been free from recurrence of abscess, as of 6 months after the operation. Abdominal wall abscess due to perforated appendicitis with mesh plug is rare, but this possibility must be considered after inguinal hernioplasty. Abdominal CT alone is insufficient to identify the mesh and to diagnose the inguinal region. Laparoscopic approach preceded to the surgery was useful in the diagnosis in our case. Although we couldn't completely remove the mesh, appendectomy and percutaneous drainage resolved the inflammation in the groin.