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Prosthetic mesh used for inguinal and ventral hernia repair: normal appearance and complications in ultrasound and CT

Departments of ¹ Radiology and ² Surgery, Hospital Sierrallana, C/ Barrio de Ganzo s/n, Torrelavega 39300, Cantabria and ³ Infectious Disease Unit, Hospital Universitario Marqués de Valdecilla, C/ Valdecilla s/n, Santander 39008, Cantabria, Spain

View larger version (149K): [in a new window]   Figure 1. Plain film radiograph in a patient with ventral hernia repair. Only the staples (arrows) that fix the mesh to the abdominal fascia are seen with this technique.

View larger version (34K): [in a new window]   Figure 2. Normal appearance of the polypropylene (PP) and expanded polytetrafluorethylene (e-PTFE) meshes on ultrasound. (a) Transverse ultrasound at the level of the left inguinal canal in a patient with a laparoscopic repair. The PP mesh appears as an echogenic line (thick arrows). (b) Transverse ultrasound at the level of the hypogastrium in a 69-year-old woman with laparoscopic surgery for ventral hernia and an e-PTFE mesh located intraperitoneally. The e-PTFE mesh (long arrow) appears as an echogenic line.

View larger version (57K): [in a new window]   Figure 3. Normal CT appearance of the polypropylene (PP) and expanded polytetrafluorethylene (e-PTFE) meshes. (a) CT scan of the same patient showed on Figure 2a. The PP mesh (long arrow) appears as a line with a similar density to the adjacent muscles. (b) Same patient of Figure 2b: the e-PTFE mesh (thick arrow) appears on CT as a hyperdense line behind the abdominal wall muscles.

View larger version (115K): [in a new window]   Figure 4. Fluid collections. Haematoma (*) above the mesh in a 68-year-old woman with laparoscopic surgery for ventral hernia and expanded polytetrafluorethylene (e-PTFE) mesh inserted. The e-PTFE mesh is visible as a line of high density (arrow).

View larger version (89K): [in a new window]   Figure 5. Atypical haematoma. A 35-year-old man with right inguinal hernia surgery 25 days before, developed a painful mass in the right inguinal canal. The ultrasound performed, showed an anechoic mass with thick septae, which made difficult to differentiate haematoma and hernia recurrence. In this case, the clinical findings and a CT performed after the administration of oral contrast excluded hernia recurrence. In addition, due to pain persistence, a surgical drainage of the collection was performed and serohematic fluid was extracted.

View larger version (56K): [in a new window]   Figure 6. Atypical haematoma. A 58-year-old man with bilateral inguinal hernia repair, reduction in red blood cell parameters, and a painful mass in the right inguinal canal during the immediate post-operative period. (a) Conventional CT performed at this level, showed a ight mass (*) with bubbles of gas making difficult to differentiate between hernia recurrence and haematoma or seroma. (b) Conventional CT scan performed at the same level as (a) after administration of oral contrast. Important to note how the normal size bowel has been displaced by the mass (*). In this patient the clinical findings and the lack of ancillary features associated with true hernia excluded hernia recurrence.

View larger version (58K): [in a new window]   Figure 7. Mesh related infection. A 53-year-old man with ventral hernia repair and a polypropylene (PP) mesh inserted 7 years before. The patient was admitted to hospital due to epigastric pain and temperature. (a) Transverse ultrasound at the epigastric level. The PP mesh (long arrow) is surrounded by a purulent collection (*). In this patient apart from antibiotic treatment, puncture and drainage of the collection was performed under ultrasound guidance and an 8 French catheter was left under the PP mesh. (b) CT scan performed several days after drainage. Note the catheter in the abdominal wall. The PP mesh is not visible.

View larger version (126K): [in a new window]   Figure 8. Bowel adherence to the mesh. A 71-year-old woman with a polypropylene (PP) and a posterior expanded polytetrafluorethylene (e-PTFE) mesh inserted for ventral hernia and successive episodes of subocclusive ileus. In CT the small bowel is seen in contiguity with the e-PTFE mesh (thick arrow). Surgical exploration confirmed adherence of the small bowel to the PP and e-PTFE meshes. Also noted small hernia on the left of the e-PTFE mesh.

View larger version (66K): [in a new window]   Figure 9. Spermatic cord complications. A 58-year-old man with inguinal hernia repair performed 30 days before, and a mass in the right inguinal canal. (a) The ultrasound performed showed a thicken spermatic cord (head arrows). (b) 1 year later the spermatic cord presents a normal size (*).

View larger version (96K): [in a new window]   Figure 10. Hernia recurrence. A 55-year-old woman with epigastric pain during the immediate post-operative period after ventral hernia repair and an expanded polytetrafluorethylene (e-PTFE) mesh insertion. Recurrence of the hernia is seen in the inferior border of the e-PTFE (arrow). Staple failure was the reason for hernia recurrence.