Enterocutaneous Fistula and Abscess Diagnosed with Point-of-care Ultrasound

Case Presentation: A 64-year-old female with history of umbilical hernia repair with mesh 18 years prior, cystocele, and diabetes mellitus presented with 10 days of abdominal and flank pain. The patient was tachycardic, normotensive, afebrile, and had an erythematous, tender, protuberant abdominal w...

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Autores principales:	Sarah McCuskee, Kenton L. Anderson
Formato:	article
Lenguaje:	EN
Publicado:	eScholarship Publishing, University of California 2021
Materias:	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/23ed9b4c948344ff877cfaec9006be6c
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spelling	oai:doaj.org-article:23ed9b4c948344ff877cfaec9006be6c2021-11-23T20:02:52ZEnterocutaneous Fistula and Abscess Diagnosed with Point-of-care Ultrasound2474-252X10.5811/cpcem.2021.4.49918https://doaj.org/article/23ed9b4c948344ff877cfaec9006be6c2021-11-01T00:00:00Zhttps://escholarship.org/uc/item/18s8d9fjhttps://doaj.org/toc/2474-252XCase Presentation: A 64-year-old female with history of umbilical hernia repair with mesh 18 years prior, cystocele, and diabetes mellitus presented with 10 days of abdominal and flank pain. The patient was tachycardic, normotensive, afebrile, and had an erythematous, tender, protuberant abdominal wall mass. Point-of-care ultrasound (POCUS) revealed an irregular, heterogeneous extraperitoneal fluid collection with intraperitoneal communication; these findings were consistent with an abscess and infected mesh with evidence for intraperitoneal extension. The diagnosis of enterocutaneous fistula (ECF) with infected mesh and abdominal wall abscess was confirmed with computed tomography and the patient was admitted for antibiotics and source control. Discussion: A rare complication of hernia repair with mesh, ECF typically occurs later than more common complications including cellulitis, hernia recurrence, and bowel obstruction. In the emergency department, POCUS is commonly used to evaluate for abscess; in other settings, comprehensive ultrasound is used to evaluate for complications after hernia repair with mesh. However, to date there is no literature reporting POCUS diagnosis of ECF or mesh infection. This case suggests that distant surgery should not preclude consideration of mesh infection and ECF, and that POCUS may be useful in evaluating for these complications.Sarah McCuskeeKenton L. AndersoneScholarship Publishing, University of CaliforniaarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENClinical Practice and Cases in Emergency Medicine, Vol 5, Iss 4 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Sarah McCuskee Kenton L. Anderson Enterocutaneous Fistula and Abscess Diagnosed with Point-of-care Ultrasound
description	Case Presentation: A 64-year-old female with history of umbilical hernia repair with mesh 18 years prior, cystocele, and diabetes mellitus presented with 10 days of abdominal and flank pain. The patient was tachycardic, normotensive, afebrile, and had an erythematous, tender, protuberant abdominal wall mass. Point-of-care ultrasound (POCUS) revealed an irregular, heterogeneous extraperitoneal fluid collection with intraperitoneal communication; these findings were consistent with an abscess and infected mesh with evidence for intraperitoneal extension. The diagnosis of enterocutaneous fistula (ECF) with infected mesh and abdominal wall abscess was confirmed with computed tomography and the patient was admitted for antibiotics and source control. Discussion: A rare complication of hernia repair with mesh, ECF typically occurs later than more common complications including cellulitis, hernia recurrence, and bowel obstruction. In the emergency department, POCUS is commonly used to evaluate for abscess; in other settings, comprehensive ultrasound is used to evaluate for complications after hernia repair with mesh. However, to date there is no literature reporting POCUS diagnosis of ECF or mesh infection. This case suggests that distant surgery should not preclude consideration of mesh infection and ECF, and that POCUS may be useful in evaluating for these complications.
format	article
author	Sarah McCuskee Kenton L. Anderson
author_facet	Sarah McCuskee Kenton L. Anderson
author_sort	Sarah McCuskee
title	Enterocutaneous Fistula and Abscess Diagnosed with Point-of-care Ultrasound
title_short	Enterocutaneous Fistula and Abscess Diagnosed with Point-of-care Ultrasound
title_full	Enterocutaneous Fistula and Abscess Diagnosed with Point-of-care Ultrasound
title_fullStr	Enterocutaneous Fistula and Abscess Diagnosed with Point-of-care Ultrasound
title_full_unstemmed	Enterocutaneous Fistula and Abscess Diagnosed with Point-of-care Ultrasound
title_sort	enterocutaneous fistula and abscess diagnosed with point-of-care ultrasound
publisher	eScholarship Publishing, University of California
publishDate	2021
url	https://doaj.org/article/23ed9b4c948344ff877cfaec9006be6c
work_keys_str_mv	AT sarahmccuskee enterocutaneousfistulaandabscessdiagnosedwithpointofcareultrasound AT kentonlanderson enterocutaneousfistulaandabscessdiagnosedwithpointofcareultrasound
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Enterocutaneous Fistula and Abscess Diagnosed with Point-of-care Ultrasound

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