David Parizh, MS, DO, Vadim Meytes, DO, George S Ferzli, MD, FACS. NYU Lutheran Medical Center
Introduction: Over the past two decades, sub-urethral sling procedures have become a popular option for surgical treatment of stress urinary incontinence. They are, however, not without complications; some of which lead to further surgical interventions. Some of the complications include voiding dysfunctions, urinary tract infections, retro-pubic hematomas, bladder injuries, vaginal extrusions and bowel injury have all been reported. Here we present a case of a 78 year old female that presented to our institution with cecal volvulus caused by an extruded bladder sling.
Case Presentation: 78 y/o female presented with a 1 day history of abdominal pain associated with nausea. Past medical history was significant for hypertension, hypothyroidism, lymphoma, total abdominal hysterectomy and a trans-vaginal sub-urethral sling procedure for a cytocele. CT scan revealed that the patient had a cecal volvulus and was subsequently taken to the operating theater for diagnostic laparoscopy. Upon insertion of the laparoscope, a large cecal volvulus with ischemic bowel was visualized with an adhesive band originating from extruded pelvic mesh as the causative agent. The colon was detorsed laparoscopically, and a small midline incision was made to resect the ischemic segment with primary ileocolic anastomosis. The patient had an uncomplicated postoperative course and was discharged home.
Discussion: Sub-urethral bladder sling surgery is becoming increasingly more popular for the treatment of female stress urinary incontinence. Multiple complications have been discussed in literature mainly dealing with postoperative pain and hematomas. However, more serious complications such as mesh extrusion and bowel injury are exceedingly rare. Here we presented a case of exposed intra-abdominal pelvic mesh causing a cecal volvulus. Even in such a complicated case, we document a systematic laparoscopic approach in order to reduce postoperative pain and length of stay. With advent of new techniques and mesh material, intra-abdominal catastrophes will have a wider array of etiologies and create a platform to challenge the advanced laparoscopic surgeon.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77705
Program Number: V184
Presentation Session: Video Loop
Presentation Type: VideoLoop