P185 - INCISIONAL HERNIA REPAIR COMPLICATING INFLAMMATORY BOWEL DISEASE
(Room Poster Hall)
19 Jan 18
5:30 PM
-
7:00 PM
Tracks:
Management of Complicated IBD
Background: The incidence of incisional hernia (IH) in inflammatory bowel disease (IBD) ranges from 4-20% due to risk factors such as multiple surgeries, immunosuppressives and nutritional issues. However, little is known about the outcome of IH repair in IBD patients. Case: A 56 year old Caucasian female with Crohn’s disease (CD) of the small and large intestine diagnosed 17 years ago presented with abdominal pain and diarrhea. She has secondary loss of response to infliximab, adverse reaction to adalimumab and certolizumab. She had ileocecal resection 10 years ago and small bowel resection with IH repair 6 years ago. She was maintained on vedolizumab (VDZ) every 4 weeks with partial clinical response. Ileo-colonoscopy was normal and MR enterography showed mild enhancement of distal small bowel. Since this did not correlate with her symptoms and biomarker elevation, after a patency capsule confirmed passage, video capsule endoscopy (VCE) was performed showed active inflammation in small bowel. Retained VCE was noted on imaging. Ustekinumab was added for worsening pain and elevated CRP. Due to worsening obstructive symptoms, surgery was performed which showed adherence of intestines to the mesh and capsule was not removed as removal would involve significant small bowel resection and injury to major vasculature. Her capsule eventually passed but later developed intra-abdominal abscess which required surgical debridement. Follow up imaging showed improvement in abscess and she is tolerating regular diet. Discussion: Higher rates of IH recurrence are seen in CD with post-operative complications like adhesions, wound infections and development of entero-cutaneous fistulas are higher with intra-peritoneal mesh hernia repair compared to pre-peritoneal mesh. This case warrants caution performing IH repair with mesh in IBD patients who may need future surgeries as the mesh poses difficulty to access intra-peritoneal contents with significant post-operative morbidity.