膀胱脫垂以UPHOLD人工網膜修補手術後之小腸損傷
莊毓峰、許兆畬、童敏哲、歐宴泉
童綜合醫院 外科部 泌尿外科
Small Intestinal Perforation After Cystocele Repair With UPHOLD
Yu-Feng Chuang, Chao-Yu Hsu, Min-Che Tung, Yen-Chuan Ou
Divisions of Urology, Department of Surgery, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan
Purpose: We report the first case of small intestinal injury after vaginal mesh kits for cystocele repair after papers review. The cause of intestinal injury is not from penetration of small bowel by vaginal mesh kit, it may be from adhesion of bowel and peritoneum with traction injury during manipulation.
Case Report: A 65 years old female complains of bulging mass over perineal region for more than 3 years. She has history abdominal total hysterectomy for benign uterine lesion (myoma?) 20 years ago and pG2T2N0M0 adenocarcinoma of middle rectum status post restorative proctectomy with pelvic lymph node dissection and coloanal anastomosis two years ago. Videourodynamic proved grade 3 cystocele with very mild stress urinary incontinence. Ventral incisional hernia and bowel adhesion status post laparoscopic enterolysis and repair of ventral hernia one month ago. She decided to have cystocele repair with Uphold one month after the above procedure due to grade 3 cystocele. Unfortunately, right lower quadrant abdominal pain and shift to right upper abdomen pain developed within 3days after cystocele repair. CT scan of abdomen showed intra-abdominal free air 3rd day after the operation. On the 5th day after the operation, small intestinal perforation and intra-abdominal abscess disclosed during diagnostic laparoscopy. The operation then converted to open segmental resection with side-to-side anastomosis.
Conclusion: Review the papers, complication from mesh kits for prolapse including mesh erosion or extrusion, bladder injury, dyspareunia, dysuria, rectal perforations, perirectal hematoma, prolapsed in untreated compartment. However, this is the first case of small intestine injury after vaginal mesh kits for cystocele repair, contraindication to use mesh kits for cystocele may include history of hysterectomy, proctectomy and intestinal adhesion.