Clinical Insights and Brief Research Report on Mesh Erosion Into Bowel Following Hernia Repair: A Single-Centre Series of Eight Cases

Abstract

Abstract: Background: Mesh erosion into the bowel is a rare but severe complication following hernia repair. Though synthetic mesh reduces recurrence rates, it carries risks of chronic infection, adhesion, and erosion. Literature is limited to isolated reports, and this case series aims to provide clinical insights into diagnosis and management challenges. Methods: We retrospectively reviewed eight patients with mesh-bowel erosion at a tertiary care centre in Delhi, India (2016-2025). Data on clinical presentation, surgical history, imaging, and management were analyzed. All patients underwent exploratory laparotomy with bowel resection and mesh removal when feasible. Results: The series included eight patients with a median age of 67 (range: 50–75). The time from initial surgery to erosion was highly variable, ranging from weeks to over 20 years. These complications arose from meshes placed in various anatomical planes, including onlay, preperitoneal, retrorectus, and intraperitoneal positions. The predominant clinical presentation was an enterocutaneous fistula (7/8 patients), with the small bowel as the most common erosion site. Preoperative imaging often underestimated the extent of erosion, which was confirmed intraoperatively. All patients required laparotomy; management included bowel resection (n=7), mesh explantation (n=6), and stoma formation (n=5). One patient died from sepsis. Conclusion: Mesh erosion into the bowel, though infrequent, leads to significant morbidity and requires a high index of suspicion, especially in patients with vague abdominal complaints and history of hernioplasty. Timely diagnosis, aggressive surgical management, and multidisciplinary care are key to optimizing outcomes.