Revisiting Mesh-Cancer : An Unusual and Devastating Complication of Chronic Mesh Infection

Background: The degeneration of chronic mesh infection into squamous-cell carcinoma (SCC) of the abdominal is related to a continuous inflammatory response against infection. The treatment is challenging and requires radical tumor resection and simultaneous reconstruction of the abdominal wall. Adjuvant radiation and chemotherapy are necessary to improve the outcomes. The objective of this report is to address rare, but devastating complication of mesh infection. Case presentation: We report the case of a patient presenting with an extensive SCC of the anterior abdominal wall, related to a longstanding polypropylene mesh infection. The surgical approach included the resection of the tumor including the right rectus muscle and the small bowel, invaded by the tumor. The reconstruction of the abdominal wall required an intraperitoneal repair with a synthetic coated mesh. He was submitted to adjuvant chemotherapy with Cisplatin and Paclitaxel, and a secondary chemotherapy scheme with Cisplatin and Fluorouracil. Radiation therapy was used to suppress lymph nodal disease in his armpits and groins. The disease progressed with extensive ulceration and infection in his left groin, causing his death after 17 months of follow-up. Conclusions: SCC of the abdominal wall is related to chronic mesh infection. Local treatment requires complete tumor excision, along with a challenging reconstruction of the abdominal wall. In this case, the use of a coated synthetic mesh allowed a reliable reinforcement and the closure of an extensive defect, after tumor resection. Adjuvant chemotherapy and radiation therapy were necessary to control metastatic disease. infection and the need for simultaneous bowel resection are usually considered absolute contraindications to performing the necessary repair using synthetic mesh [2]. SCC of the abdominal wall is extremely aggressive and, adjuvant radiation and chemotherapy are required to improve the outcomes.