Colorectal adenocarcinoma infiltrating inguinal hernia mesh: a case report and systematic review

Bonnie Lee; Carlos Balthazar da Silveira; Joel Eastes; Margaret Hogan; Ana Rasador; Ava Nierva; Vikram Deka; Thomas Gillespie; Conrad Ballecer

doi:10.18203/2349-2902.isj20261585

Authors

Bonnie Lee Department of Surgery, Creighton University School of Medicine, Phoenix, Arizona, USA
Carlos Balthazar da Silveira Department of Surgery, Creighton University School of Medicine, Phoenix, Arizona, USA; Department of Surgery, Surgery, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
Joel Eastes Department of Surgery, Creighton University School of Medicine, Phoenix, Arizona, USA
Margaret Hogan Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin, USA
Ana Rasador Department of Surgery, Surgery, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
Ava Nierva Department of Medicine, Saint Louis University, St. Louis, Missouri, USA
Vikram Deka Department of Surgery, Surgery, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
Thomas Gillespie Department of Surgery, Creighton University School of Medicine, Phoenix, Arizona, USA; Department of Surgery, Surgery, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA
Conrad Ballecer Department of Surgery, Creighton University School of Medicine, Phoenix, Arizona, USA; Department of Surgery, Surgery, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA

DOI:

https://doi.org/10.18203/2349-2902.isj20261585

Keywords:

Inguinal hernia, Abdominal wall, Adenocarcinoma

Abstract

Inguinal hernia repairs are standard procedures globally, but while reducing recurrence, they can introduce complications such as infection, migration, and bowel obstruction. The extent of prosthetic mesh involvement in synchronous malignancies, particularly regarding cancer seeding or direct invasion, remains underexplored. This case report highlights an uncommon presentation of colorectal adenocarcinoma, initially manifesting as a mesh-related complication, in a 74-year-old male with a history of two previous right inguinal hernia repairs. Initial evaluations, including colonoscopy and carcinoembryonic antigen levels, offered no indication of cancer. However, subsequent investigation led to robotic adhesiolysis, preperitoneal debridement, and mesh explantation, definitively revealing metastatic moderately differentiated adenocarcinoma on the mesh, strongly suggesting a colorectal primary neoplasia. Despite multiple interventions and chemotherapy, the patient developed progressive metastasis. We identified only 8 reported cases describing mesh invasion or complications due to various primary tumors presenting as inguinal masses, pain, or swelling, making this an extremely rare complication. Surgical management in these cases primarily involved tumor resection and mesh removal, with mixed outcomes. This case therefore underscores the rare but significant occurrence of metastatic colorectal adenocarcinoma seeding prosthetic mesh following inguinal hernia repair.

References

Zendejas B, Ramirez T, Jones T, Kuchena A, Martinez J, Ali S, et al. Trends in the utilization of inguinal hernia repair techniques: a population-based study. Am J Surg. 2012;203(3):313-7.

Gossetti F, D'Amore L, Annesi E, Bruzzone P, Bambi L, Grimaldi M, et al. Mesh-related visceral complications following inguinal hernia repair: an emerging topic. Hernia. 2019;23:699-708.

Pocard M, Valliant J, Fritsch S, Aoudjhane M, Najman A, Parc R. Possible first report of distant peritoneal metastases from a nodal mesenteric lymphoma after laparoscopic inguinal hernia repair. Europ J Surg Oncol. 1999;25(6):635-6.

Li S, Li Y, Tang L, Zhao P. Obstructed small bowel ruptured toward the inguinal canal resulting from metastatic colon carcinoma in an irreducible, recurrent inguinal hernia with mesh-plug repair: Report of a case. Eur J Surg Oncol. 2010;36(10):1012-4.

Imai M, Kondo Y, Masuko H, Okada K, Osawa S, Ishizu H, et al. Distant Peritoneal Metastasis to a Mesh-Plug Prosthesis in a Gastrointestinal Cancer Patient: Report of a Case. Surg Today. 2003;33:864-6.

Simonelli V, Boven C, Loi P, El Nakadi I, Closset J. Intraperitoneal mesh prosthesis metastasis from pancreatic cancer, after laparoscopic hernia repair. Acta Chirugica Belgica. 2016;116(1):51-3.

Shigeyoshi I, Komori K, Kinoshita T, Oshiro T, Ito S, Abe T, et al. Peritoneal cecal cancer metastasis to a mesh-plug prosthesis: A case report. J Med Invest. 2018;65(1.2):142-6.

Kudou M, Murayama Y, Konishi H, Komatsu S, Shiozaki A, Kuriu Y, et al. Peritoneal colon cancer metastasis to bilateral inguinal hernia repair sites: report of a case. Surg Today. 2015;45:1053-7.

Ueda S, Saito T, Fukami Y, Komatsu S, Kaneko K, Sano T. A case of enormous retroperitoneal liposarcoma with prolapse from the left inguinal canal following hernia repair. Surg Case Rep. 2024;10(1):101.

Aso K, Ito K, Takemura N, Inagaki F, Mihara F, Kokudo N. Solitary Peritoneal Metastasis of Pancreatic Tail Cancer to a Surgical Mesh for Inguinal Hernia Repair: A Case Report and Literature Review. Pancreas. 2024;53(4):e380-e383.

Rajaram R, Aelvoet C. An unusual finding in the follow-up of a transabdominal pre-peritoneal (TAPP) implanted mesh for inguinal hernia. Acta Chir Belg. 2008;108(5):600-1.

Bouillot JL, Aouad K, Alexandre JH. Parietal mesh abscess as an original presentation of cancer of the caecum. Dig Surg. 1999;16(2):158-60.