Transobturator tape erosion associated with leg pain.
A 39 year-old vaginal multipara status postpubovaginal sling in 2002 and a transobturator tape procedure in 2004 presented with persistent stress incontinence and vaginal polypropylene mesh erosion. Ten days later, she presented to the emergency room with severe right groin pain, difficulty walking, fever, and chills. She described shooting pain originating from the right inguinal ligament radiating down her right leg anteriorly. Although her neurologic examination was normal, palpation of the right obturator internus muscle reproduced her pain. MRI clearly revealed the course of the mesh tape through the obturator muscles and marked increase in the size of the right adductor and obturator internus muscles, apparently compressing the adjacent neurovascular fascicle. The patient was taken to the operating room where the polypropylene tape was easily removed through the vaginal erosion. Mesh cultures were positive for bacteroides fragilis. She experienced complete symptom resolution within 1 week of tape removal.
Mahajan
Sangeeta T
ST
Division of Female Pelvic Medicine and Reconstructive Surgery Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, IL 60153, USA. smahajan@lumc.edu
Kenton
Kimberly
K
Bova
Davide A
DA
Brubaker
Linda
L
D000328:Adult; D001442:Bacteroides Infections / Q000150:complications*; D001441:Bacteroides fragilis; D020878:Device Removal; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications* / Q000382:microbiology; D006801:Humans; D007866:Leg / Q000382:microbiology; D008279:Magnetic Resonance Imaging; D018482:Muscle, Skeletal / Q000382:microbiology / Q000473:pathology; D010146:Pain / Q000209:etiology* / Q000382:microbiology; D019736:Prostheses and Implants / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000150:complications*