Late-Onset Mesh Migration Following Hernia Repair: Two Cases of Enteric Fistulization

Abstract

Mesh migration is a rare but serious late complication of hernia repair, often presenting years or even decades after implantation. Its clinical manifestations are nonspecific, making diagnosis challenging and frequently delayed until advanced complications occur. We report two female patients with a history of multiple abdominal surgeries and prior mesh implantation who developed severe complications related to mesh migration. The first case involved an 86-year-old woman presenting with acute right lower quadrant pain; intraoperative findings revealed mesh erosion into the transverse colon and distal ileum, forming an entero-colonic fistula and abscess. Despite staged surgical management, her course was complicated by necrotizing esophagitis and fatal hemodynamic collapse. The second case involved a 61-year-old woman with Crohn’s disease, in whom mesh erosion into the small bowel produced recurrent fistulization and adhesive syndrome, requiring multiple laparotomies and partial mesh removal. She survived but was discharged with a high-output external enterocutaneous fistula under multidisciplinary follow-up. These cases illustrate the potential for late-onset mesh migration to cause life-threatening complications, including multiorgan involvement and persistent fistulas, long after hernia repair. They highlight the importance of maintaining clinical suspicion in patients with prior mesh implantation presenting with nonspecific abdominal symptoms, and raise questions about the need for long-term surveillance strategies and the exploration of safer prosthetic materials to reduce the risk of catastrophic outcomes.