Meshoma: Rare Late Complication of Inguinal Hernia Detectable by Ultrasound — A Case Report
Italy: Meshoma is an uncommon but potentially serious late complication of inguinal hernia repair. Ultrasound serves as a valuable first-line imaging tool, enabling direct visualization of mesh folding and related fistulous tracts, thus aiding timely surgical management. A recent case report published in the Journal of Ultrasound by Giulio Cocco and colleagues highlights the critical role of ultrasound in diagnosing this rare but clinically significant condition.
Meshoma refers to the abnormal contraction and folding of a prosthetic mesh used in hernia repair, which can lead to chronic inflammation and, in some cases, infection. Clinical presentation is often nonspecific, making early diagnosis challenging. In certain cases, complications such as sinus formation or cutaneous fistula may arise due to persistent infection, further complicating the clinical picture.
The report describes a 46-year-old man who presented with fever and worsening pain in the left groin region. His symptoms were localized to the site of a prior inguinal hernia repair performed a decade earlier using a plug-and-patch technique. On examination, a firm and tender mass was detected in the affected area. Laboratory findings revealed elevated inflammatory markers, including leukocytosis and high C-reactive protein levels, indicating an ongoing infection.
Ultrasound examination played a pivotal role in the diagnostic process. Imaging revealed a highly echogenic, irregular, folded structure with posterior acoustic shadowing, consistent with a meshoma. The lesion was located within the superficial subcutaneous tissue and was surrounded by inflammatory changes, including a fluid rim and a fibrous capsule. Notably, a thin tract extending from the meshoma to the skin surface was identified, suggestive of a cutaneous fistula. Increased vascularity around the lesion on Doppler imaging further supported active inflammation.
Based on these findings, a diagnosis of infected meshoma with cutaneous fistulization was made. Although the patient initially responded to intravenous antibiotics, with resolution of fever and normalization of inflammatory markers, the persistent painful mass necessitated surgical intervention. During surgery, dense adhesions and purulent material were encountered around the mesh, confirming the diagnosis. Complete removal of the infected mesh along with the fistulous tract was performed.
The patient’s postoperative course was uneventful, with complete resolution of symptoms. Follow-up at three and six months showed no recurrence of hernia or infection, underscoring the effectiveness of timely surgical management.
The case highlights the importance of considering mesh-related complications in patients presenting with delayed groin symptoms following hernia repair. High-resolution ultrasound emerges as an essential diagnostic tool, allowing real-time assessment of mesh integrity, surrounding inflammation, and associated complications such as fistula formation. Early and accurate identification can facilitate prompt intervention, potentially preventing more severe outcomes such as extensive infection or visceral involvement.
Reference:
Cocco, G., Corvino, A., Ricci, V. et al. Ultrasound diagnosis of an inguinal meshoma complicated by cutaneous fistula: a case report. J Ultrasound (2026). https://doi.org/10.1007/s40477-026-01149-5
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