Ultrasound diagnosis of an inguinal meshoma complicated by cutaneous fistula: a case report

Background: The development of a meshoma, resulting from excessive contraction and folding of a prosthetic mesh after inguinal hernia repair, represents a rare but clinically relevant complication. Sometimes, a sinus tract or cutaneous fistula may also develop as a result of a local infection. Early diagnosis is often challenging due to a poorly specific clinical presentation that makes point-of-care ultrasound imaging pivotal for a prompt assessment. Case summary: A 46-year-old man presented with fever and recurrent left groin pain several years after open inguinal hernia repair with a plug-and-patch technique. A hyperechoic folded structure with posterior acoustic shadowing, consistent with a meshoma, surrounded by hypoechoic inflammatory changes of the soft tissues, was identified on ultrasound examination. Additionally, a thin hypoechoic linear tract extending from the meshoma to the skin surface was also identified, consistent with a cutaneous fistula. Despite partial clinical improvement with systemic antibiotic therapy, due to the persistent painful local mass, a surgical exploration was performed, confirming an infected meshoma with cutaneous fistulization. Complete removal of the prosthetic material led to full clinical resolution, with no recurrence during follow-up. Conclusion: Meshoma is an uncommon but potentially severe late complication of inguinal hernia repair. Ultrasound represents a valuable first-line imaging modality, allowing direct visualization of mesh folding and associated fistulous tracts and facilitating prompt surgical management.