P0418 - Colo-Cutaneous Fistula Formation Secondary to Infected Mesh Leading to Recurrent Abscess Formation Successfully Treated With an Over the Scope Clip (OTSC)

Hamza Akhtar, MD¹, Aleena Khan, MD¹, Nathan P. Heller, MD¹, Mahesh Nepal, MD¹, Prajjwol D. Bhatta, MD¹, Sushrut Ingawale, MD, DNB, MBBS², Erik Olson, DO¹
1Rochester General Hospital, Rochester, NY; 2Quinnipiac University - Frank H Netter MD School of Medicine, Bridgeport, CT

Introduction:

Retained biomesh can lead complex complications, including fistula formation and difficult-to-treat abdominal wall abscesses. The over the scope clipping system (OTSC) is a device that allows for endoscopic closure of large defects. We present a case with severe complications after appendiceal tumor removal; incisional hernia requiring mesh repair, subsequent mesh infection and a vicious cycle of recurrent abscess formation. An OTSC was used to clip the fistula opening resulting in closure and improvement of infection.

Case Description/

Methods:

We report the case of a 56-year-old female with past medical history of depression/anxiety, obesity, former smoking who presented to our hospital with recurrent abdominal wall abscesses. A year prior, she had underwent laparoscopic appendectomy and intraperitoneal chemotherapy (HIPEC) for a low grade appendiceal tumor. Recovery was complicated by incisional hernia requiring mesh repair which was subsequently infected. This resulted in prolonged hospitalizations for abdominal wall abscesses requiring IR drains with cultures revealing enteric bacteria. Colonoscopy revealed a large fistulous tract in the transverse colon with pus and mesh remains. Due to concern for colonic integrity, we proceeded with Ovesco clip closure of fistula. Follow up CT scans revealed resolving abscesses and repeat colonoscopy confirmed fistula closure. Thereafter, the patient underwent laparotomy with removal of mesh remains and adhesiolysis resulting in complete resolution of symptoms.

Discussion:

The formation of a colocutaneous fistula is a very rare occurrence after hernia mesh implantation, and occurs in well under 1% of cases. It can lead to intractable abscess formation which are challenging to treat. The OTSC has become an increasingly utilized option for GIB, perforations and anastomotic leaks, however its efficacy in fistula closure is not well established. Our case demonstrated an excellent outcome for our patient with recurrent abdominal abscesses refractory to treatment. 


Figure: Biomesh identified protruding from a fistula opening in the transverse colon.


Figure: Fistula closure from the colonic aspect during OTSC application

Disclosures:
Hamza Akhtar indicated no relevant financial relationships.
Aleena Khan indicated no relevant financial relationships.
Nathan Heller indicated no relevant financial relationships.
Mahesh Nepal indicated no relevant financial relationships.
Prajjwol Bhatta indicated no relevant financial relationships.
Sushrut Ingawale indicated no relevant financial relationships.
Erik Olson indicated no relevant financial relationships.

Hamza Akhtar, MD¹, Aleena Khan, MD¹, Nathan P. Heller, MD¹, Mahesh Nepal, MD¹, Prajjwol D. Bhatta, MD¹, Sushrut Ingawale, MD, DNB, MBBS², Erik Olson, DO¹. P0418 - Colo-Cutaneous Fistula Formation Secondary to Infected Mesh Leading to Recurrent Abscess Formation Successfully Treated With an Over the Scope Clip (OTSC), ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.