Rare delayed complication of laparoscopic sacrocervicopexy with synthetic mesh.

To cite: Teixeira NF, Serrano P, Ferreira A, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2014-206513 DESCRIPTION We report a case of a 56-year-old-woman with obstetric/gynaecological history of two normal deliveries and diagnosis of pelvic organ prolapse (third degree uterine prolapse) at the age of 37. She underwent a laparoscopic sacrocervicopexy 16 years ago, in another medical institution. She presented to the gynaecological outpatient clinic with pelvic pain and recurrent purulent vaginal discharge during the past 3 months. Examination showed purulent discharge arising from a small opening in the upper third of the right vaginal wall and a fistulography and an abdominopelvic MRI were requested. The fistulography demonstrated a vaginal fistula, not conclusive about the anatomical structures involved (figure 1). MRI revealed a right fistulous tract extending from vaginal towards a retroperitoneal saccular area, up to the promontory level, probably a pelvic abscess (figure 2A, B). A laparotomy was decided and intraoperative findings were consistent with a large abscess in the presacral retroperitoneal space up to the level of promontory, inside which it was found a Y-shaped non-absorbable mesh inserted between lateral sidewalls of cervix and promontory (figures 3 and 4). The patient underwent a hysterectomy, infected mesh removal, abscess drainage and retroperitoneal space exploration. The postoperative period was uneventful and she was discharged home well on the third postoperative day. At 3-month follow-up she was totally asymptomatic. This is a report of an extremely rare delayed complication of a pelvic abscess associated with a vaginal fistula that presented 16 years after a laparoscopic sacrocervicopexy. The strategy involving identification, diagnostic approach and treatment management of mesh-related complications must be individualised. 2 Figure 1 Fistulography: X-ray taken after contrast injection through the opening in the upper third of the right vaginal wall showing the length, shape and direction of the fistulous tract.