Two Rare Cases of Mesh Infection Due to Mycobacterium abscessus Following Laparoscopic Inguinal Hernia Repair.
Alexis A Heilman, Wihan Du Plessis, Edward P Dominguez et al.
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Case in brief
Two patients developed delayed groin pain and fluid collections after total extraperitoneal laparoscopic inguinal hernia repair. Cultures identified Mycobacterium abscessus, a multidrug-resistant nontuberculous mycobacterium. Both infections required removal of the mesh and prolonged multidrug antibiotic therapy; infection resolved in both patients after approximately 12 months. Investigation suggested contamination of laparoscopic instrument sheaths as the source, leading to changes in sterilization protocols.
What made this case unusual
The infections involved mesh and were caused by M. abscessus, with instrument-sheath contamination suspected as the source. The organism’s biofilm formation and resistance to sterilization were noted as factors contributing to persistence.
Diagnostic / clinical pearl
Consider M. abscessus in delayed pain and fluid collections after laparoscopic hernia repair; culture confirmation can identify this persistent mesh infection and inform management.
Why it matters
The suspected instrument-sheath source highlights the importance of strict sterilization protocols in preventing these serious infections.