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Commentary |

Radiologic Images of Meshoma A New Phenomenon Causing Chronic Pain After Prosthetic Repair of Abdominal Wall Hernias

Parviz K. Amid, MD
Arch Surg. 2004;139(12):1297-1298. doi:10.1001/archsurg.139.12.1297.
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Hernia surgery has been fundamentally affected by the use of prosthetic meshes, which have dramatically lowered the rate of recurrence after hernia repair. This revolutionary development, however, may lead to certain complications. Depending on the chosen procedure and the approach, the mesh is implanted in front of or behind the transversalis fascia; in the latter case, this is done through an open or laparoscopic approach. Furthermore, depending on the surgeon’s choice, the mesh is implanted without fixation or is fixed by sutures, metallic staples and tacks, or a variety of tissue glues. Nonfixation, insufficient fixation, or insufficient dissection to make adequate room for the prosthesis, however, can lead to folding and wrinkling of the mesh, a process that continues until the mesh is wadded up into a ball, which elsewhere I have referred to as “meshoma.”1Figure 1, Figure 2, Figure 3, and Figure 4 show computed tomographic and magnetic resonance images of this phenomenon and the corresponding explanted surgical specimens.

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Figure 1.

A wrinkled mesh from an incisional hernia repair following an appendectomy. A, A computed tomographic image of the wrinkled mesh. B, The explanted wrinkled mesh.

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Figure 2.

A wrinkled mesh (meshoma) subsequent to a preperitoneal inguinal hernia repair. A, A computed tomographic image of the wrinkled mesh (meshoma). B, The explanted surgical specimen.

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Figure 3.

A meshoma with compression and encasement of the ilioinguinal nerve. A, A computed tomographic image of the meshoma. B, The explanted specimen showing the resected ilioinguinal nerve completely encased within the base of a mesh plug.

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Figure 4.

A meshoma (a mesh plug) with compression and encasement of the vas deferens resulting in proximal dilatation of the vas. A, A magnetic resonance image of the meshoma. B, The explanted plug (arrow points to the site of encasement of the vas).

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Figure 5.

A meshoma compressing the bladder. A, A magnetic resonance image of the meshoma. B, The explanted meshoma.

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Figure 6.

A meshoma (asterisk) attached to a contrast-filled loop of bowel.

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Figure 7.

A meshoma attached to the iliac vessels. A indicates artery; V, vein.

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