Primary intestinal lymphoma associated with enteric fistula to an intraperitoneal mesh: what came first?

Abstract Aim To present the possible association between the use of intraperitoneal mesh and the appearance of primary intestinal lymphoma. Material and Methods We present the case of a 67-year-old woman with a history of multiple abdominal surgeries (appendectomy, Hartmann's procedure for perforated diverticulitis and reoperation due to hemoperitoneum). Ventral hernia repair was performed placing intraperitoneal composite mesh in 2013. Eight years later, the patient consulted with abdominal pain and bulging located on previous laparotomy scar. Abdominal CT was carried out, demonstrating an intestinal fistula from the jejunum to the mesh with an adjacent 5 cm intraabdominal abscess. Results Elective surgery was decided on. An enteric fistula from the jejunum to the previous mesh was observed, as well as pathologic lymph nodes adhered to the mesh. Intestinal resection was performed prior mesh excision. Histopathological analysis was compatible with extranodal B-cell lymphoma of the marginal zone. Conclusions Enteric fistula rate associated with the use of intraperitoneal mesh is 0.3–4%. There are no published cases of intestinal lymphoma correlated with the use of intraperitoneal mesh. Primary intestinal lymphoma constitutes 1–4% of bowel malignancies. The most common type is extranodal marginal zone MALT B lymphoma. Typical locations are: gastric (50%), small bowel (33–40%) and colon (10–15%). Situations of chronic inflammation such as celiac disease, inflammatory bowel disease, Campylobacter jejuni infection or inflammatory reactions are known to cause this entity. In this particular case, an excessive inflammatory response to an intraperitoneal mesh resulting in enteric fistula could be the source of malignancy, or vice versa.