LAUSR

A 53-year-old male presented to the HCFMUSP’s Abdominal Wall Clinic with a history of four surgeries in 2012 due to acute appendicitis complications: he developed a subphrenic abscess, necessitating multiple laparotomies and mesh placement, resulting in a 64-day hospitalization. He is a half-pack-a-day smoker with a BMI of 29.3 kg/m². Examination in June 2023 revealed a scarified wound, exposed mesh, and a contained eventration on one-third of the anterior abdominal wall. He experienced limiting pain and purulent discharge from the exposed mesh. A CT scan showed a 16 cm × 13 cm abdominal wall discontinuity, lateralized rectus abdominis muscles, and mesh restraining the left hepatic lobe and intestines. In March 2024, he underwent total abdominal wall reconstruction. The surgery involved removing the infected mesh and scarified skin, treating intense adhesions, and performing an opportunistic cholecystectomy. Primary abdominal wall closure was achieved using extensive bilateral Gibson's incisions and an onlay polypropylene mesh. Postoperatively, the patient did not require ICU care. He resumed ambulation and diet on the first day. Empirical oxacillin was given for 7 days until cultures identified Proteus mirabilis and Pseudomonas aeruginosa, switching to oral ciprofloxacin upon discharge. Follow-up showed no infection, hernia recurrence, or mesh exposure. Literature suggests complete excision of infected mesh. Shubinets et al. advocate for a single-stage approach with retromuscular biological meshes, while Devin, C.L. supports polypropylene meshes in infected sites. This case reinforces that synthetic onlay mesh offers good infection control, non-recurrence of hernias, and low complication rates, aligning with Birolini et al.'s findings.