Bowel Perforated During Vaginal Mesh Procedure

Case Overview

This case involves a female patient that underwent surgery to excise a sacrocolpopexy mesh that eroded into her vaginal wall. Postoperatively, the patient was afebrile and vitals were noted to be normal. The following day, the patient began to suffer from abdominal distention, anuria, abdominal pain, and tachycardia. A CT scan revealed extravasation of contrast in the pelvis from an intraluminal source. An exploratory laparotomy was performed and the operative findings indicate that there were several loops of proximal small bowel with gross perforation in the pelvis around the area of mesh removal. Two large perforations were identified, one of which was almost a complete transection through the bowel with a suture present in the bowel wall. Approximately eight to ten centimeters of bowel was removed and sent to pathology for review. The patient was also noted to have had an arrhythmia during her hospitalization. This occurred between post-op days seven and eight. A chest X-ray revealed that her bi-lateral pleural effusions and cardiac enzymes were slightly elevated. An echocardiogram revealed a small pericardial effusion with an ejection fraction between 30% and 35%, severe tricuspid regurgitation, and severe pulmonary hypertension.