Undiagnosed Vaginal Mesh Causing Chronic Pelvic/Groin Abscess: A Case Report

Objectives: To demonstrate the importance of a comprehensive diagnostic and surgical strategy of a chronic infection in the groin and pelvis of a patient with history of an unknown vaginal mesh procedure and the importance of appropriate pre-procedural planning and interdisciplinary collaboration, specifically regarding mesh related revision surgeries.

Methods: We present a 72 year old female with recurrent purulent, malodorous vaginal discharge in addition to chronic drainage from a small area in the left groin for 2 years for which she had multiple incision and drainages. She was referred to urogynecology by general surgery after admission for a perineal abscess requiring debridement. Her relevant past medical history includes history of perineal abscess with necrotizing fasciitis, T2DM, hidradenitis suppurativa, and daily tobacco use. Surgical history notable for a hysterectomy, oophorectomy, and bladder suspension done at an outside hospital with no records or operative reports available. The patient was unsure if a mesh procedure was completed at that time. On assessment with transperineal ultrasound, a hyperechoic sub-urethral material thought to be mesh was noted. Further imaging with MRI reiterated this unilateral finding as well as increased suspicion for a forming fistula and left obturator canal abscess. The video then explores the use of meticulous dissection for mesh removal and debridement of infected tissue.

Clinical Relevance: The outcomes of the surgical intervention are highlighted focusing on the successful removal of the infected vaginal mesh and the resolution of the chronic groin abscess. The patient’s postoperative course was complicated by a wound dehiscence of the groin incision and requiring antibiotics followed by daily wound packing. By six weeks, the patient’s symptoms had resolved entirely, and her wound had healed appropriately. At three months postoperatively, the patient continues to report resolution of symptoms related to the abscess and feels well overall.

This video case report emphasizes the importance of proper imaging utilization for diagnosis and treatment planning, specifically in complicated cases with unknown prior surgical interventions and retained bioproducts. The multimodal imaging obtained preoperatively demonstrates the utility of imaging for surgical planning and surgical management. We further explore the prevalence of mesh related exposures, risk factors, and what imaging modalities are most appropriate for specific clinical presentations. This case report ultimately highlights the opportunity for interdisciplinary care, pertinence of imaging selection, and importance of patient education.