Successful Conservative Treatment for Late-Onset Mesh Infection after Inguinal Hernia Repair—A Case Report—

Abstract

An 82-year-old man underwent left inguinal hernia repair using a Direct Kugel patch^® with concomitant orchidectomy for prostate cancer. He developed orchidectomy wound infection ; however, the hernioplasty wound remained uninfected. Corticosteroid therapy was initiated for skin disease, 21 months postoperatively. The patient developed fever a month later, and computed tomography showed an abscess extending from the left groin to the pelvic region. The patient was diagnosed with late-onset mesh infection and underwent percutaneous abscess drainage together with empirical administration of piperacillin/tazobactam. Methicillin-sensitive Staphylococcus aureus was isolated from pus cultures ; therefore, piperacillin/tazobactam therapy was de-escalated to only piperacillin. Finally, piperacillin was switched to oral cefaclor and minocycline treatment administered over 8 weeks, and the patient received antibiotics for a total of 10 weeks. He has been well for 1 year without relapse of the abscess observed on computed tomography. Reportedly, conservative treatment is ineffective for late-onset mesh infections, and mesh removal becomes necessary. We report a case of successful percutaneous abscess drainage and antibiotic administration without removal of the infected mesh. Physicians should be mindful that continued antibiotic administration may be required even after symptom improvement.