A Case of Late-onset, Post-hernial Repair Inguinal Mesh Infection with Intense 18F-fluorodeoxyglucose Uptake Mimicking an Appendiceal Tumor

Abstract

A 67-year-old man underwent bilateral inguinal hernial repair with a Kugel patch. One year later, he visited our hospital after he noticed a right inguinal mass. All laboratory test results were within their normal limits, and inflammatory response and tumor markers were negative. Computed tomography revealed an appendiceal mass conjoined with the abdominal wall. 18F-Fluorodeoxyglucose (FDG) uptake in the mass was significantly high on FDG-PET (examination), which led us to diagnose it as a newly originated appendiceal (neoplastic) tumor. The patient underwent laparoscopic en bloc resection of the terminal ileum and cecum, including the old mesh. He recovered without complications. As we judged the mass be a malignant tumor rather than an infection, the mesh was retained as much as possible. Histopathological examination revealed an abscess, not a malignancy, contradicting our preoperative diagnosis. During the diagnosis of a mass with FDG-PET collection at a previous surgical site, it must be kept in mind that the cause could be an infection or a neoplasm.