A closed loop obstruction through mesh defect in a ventral hernia: a surgical rarity

Abstract

Closed loop obstruction is a surgical emergency marked by localized entrapment of bowel loops between two obstructive points. While common in internal hernias and adhesions, its occurrence within a recurrent ventral hernia, particularly via a contracted mesh defect, is exceedingly rare. This case highlights the diagnostic and surgical complexities of such a presentation and underscores the need for heightened awareness in patients with prior mesh repair. A 67-year-old diabetic female with a prior history of obstructed ventral hernia repair and mesh placement presented with acute abdominal pain, vomiting, and obstipation. Imaging revealed small bowel loops herniating through a focal mesh defect with associated mesenteric twist-suggestive of closed loop obstruction. Emergency laparotomy revealed dense adhesions, herniated ileal segment with compromised vascularity, and a mesh-induced fibrotic plane. Resection and anastomosis of the involved segment was performed with primary closure of the fascial defect. The patient had an uneventful postoperative course and was discharged on day six. This case exemplifies a rare but critical complication following ventral hernia mesh repair. Mesh contraction and tissue ingrowth can inadvertently create new hernia defects. Internal herniation through such defects, especially with twisting of the mesentery, can rapidly lead to ischemia. A high index of suspicion, timely imaging, and prompt surgical exploration are crucial to prevent morbidity. This case underscores the delayed but dangerous potential of mesh-related internal herniation—a late mesh complication demanding surgical vigilance. Recurrent ventral hernias with closed loop obstruction through mesh-related defects, though rare, demand urgent recognition. This case reinforces the significance of individualized surgical planning in reoperative fields and the potential for catastrophic sequelae in the absence of timely intervention.