Delayed-onset deep mesh infection presenting as discharging sinuses years after lichtenstein hernioplasty: a case report

Abstract

Lichtenstein tension-free mesh hernioplasty is the gold standard for inguinal hernia repair due to low recurrence and minimal complications. However, delayed-onset mesh infections are rare and often underdiagnosed due to their subtle clinical presentation. They can manifest years later as chronic discharging sinuses and require high clinical suspicion for accurate diagnosis. Here a 50-year-old male presented with multiple discharging sinuses over the right inguinal region, several years after undergoing mesh hernioplasty. He was afebrile and hemodynamically stable. Magnetic resonance imaging (MRI) revealed subcutaneous T2 hyperintense collections, sinus tracts, and an enlarged lymph node. Surgery revealed purulent discharge with fibrotic adhesions and sinus tracts involving the mesh and spermatic cord, which were excised en bloc along with a lymph node. Histopathological analysis revealed foreign body-type granulomas, lymphocytic infiltration, and follicular hyperplasia, consistent with a chronic foreign body reaction. The patient received culture-sensitive antibiotics postoperatively and had an uneventful recovery with no recurrence on follow-up. Delayed-onset mesh infections are typically caused by biofilm-forming bacteria and may not respond to conservative treatment. Imaging assists in localization, but surgical removal of the infected mesh and affected tissues is the cornerstone of management. Histopathology helps confirm the chronic inflammatory response to synthetic mesh. This case emphasizes the need for long-term vigilance following mesh repair surgeries. Early recognition, thorough imaging, and prompt surgical intervention are vital for resolution. Awareness of this rare but significant complication can improve patient outcomes and reduce morbidity.