Difficulties associated with removal of mesh eroding into vagina following abdominal sacrocolpopexy: a case report

This case report describes the clinical case of a patient presenting complications during removal of mesh eroding through the lower one third of the posterior vaginal wall following abdominal sacrocolpopexy. Although excellent results have been reported with abdominal sacrocolpopexy for treatment of vaginal vault prolapse, minimizing complications and their correction remains a challenge. In this case, only 3/4 of the mesh was removed vaginally and was complicated by small bowel perforation due to adhesions. The remaining mesh was removed by careful dissection from the sacral base as the risk of infection in the mesh left behind is increased. Successful management eventually requires complete removal of the mesh at laparotomy. The surgery should be performed by experienced pelvic surgeons able to resolve intraoperative complications. Although serious complications are rare, patients should nonetheless be counselled about the risk of massive bleeding, bowel perforation, infection and rectovaginal fistula formation.