CASE REPORT D. D. Nowak Æ A. C. Chin Æ M. A. Singer W. S. Helton Large scrotal hernia: A complicated case of mesh migration, ascites, and bowel strangulation Received: 23 March 2004 / Accepted: 4 June 2004 / Published online: 24 July 2004 Ó Springer-Verlag 2004 Abstract A 30-year-old male with 1 1/2-year history of an asymptomatic, large, reducible right indirect scrotal hernia presented to the emergency department com- plaining of a 2-week history of increasing abdominal distension and daily emesis. He had recently undergone an emergent exploratory laparotomy in which his asymptomatic hernia was repaired with a mesh plug from an intra-abdominal approach. The mesh plug subsequently migrated into the patient’s scrotum resulting in a strangulating bowel obstruction. This paper discusses a serious complication that may result from inappropriate use and placement of a mesh plug and our approach to correct the situation utilizing a bioabsorbable mesh prosthesis. Keywords Mesh plug Æ Small bowel obstruction Æ Inguinal hernia Æ Ascites Æ Surgisis Background Over 730,000 inguinal hernia repairs are performed annually in the United States [1] and represent an important aspect of most general surgeons’ practices. Recent advances in biological material science and sur- gical implants along with new surgical techniques have expanded the general surgeon’s armamentarium for inguinal herniorrhaphy. Herein, we present a patient who presented with a large strangulated scrotal hernia following implantation of a mesh plug. The mesh plug was previously placed transabdominally during an exploratory laparotomy for trauma for the patient’s known asymptomatic inguinal hernia. This paper discusses a serious complication that resulted from inappropriate use of a mesh plug and our approach to correct the situation using a bioabsorbable mesh pros- thesis. Case presentation A 30-year-old African American male presented to the surgical clinic with a 1 1/2-year history of an asymp- tomatic, large, reducible right indirect scrotal hernia. He was scheduled for an elective herniorrhaphy. However, he did not show up for his scheduled operation. Several months later, he presented to our emergency room with a 2-week history of increasing abdominal distension and daily emesis. At that time, he stated that the reason he did not keep his previous appointment for elective her- nia operation was because he had been shot in the abdomen and underwent an emergent laparotomy at another hospital during which time he had his ‘‘hernia repaired internally.’’ He also stated that shortly after his trauma laparotomy, the hernia recurred. The patient’s medical history was also significant for end-stage renal disease secondary to hypertension that required hemodialysis and a history of ascites from undetermined etiology. Upon examination, the patient was clinically stable but had a distended, tense, and tender abdomen with diminished bowel sounds. There was a well-healed midline abdominal scar with no fascial defects. He had an incarcerated right scrotal hernia that was tender to palpation and a palpable mass at the apex of the right scrotum. No effort was made to reduce the hernia. An obstructive series revealed numerous dilated small bowel loops with multiple air-fluid levels. A nasogastric tube was placed, which returned 1.5 l of feculent aspirate. The patient was resuscitated and taken emergently to the operating room for operation. He consented to hernia repair, possible bowel resection, and right orchiectomy. In the operating room, the patient was prepped with iodine and draped in a wide, sterile fashion. An oblique incision was made in the right inguinal region for an D. D. Nowak Æ A. C. Chin Æ M. A. Singer Æ W. S. Helton (&) Department of Surgery, University of Illinois at Chicago, M/C 958 840 S. Wood St. Room 435E, Chicago, IL 606012, USA E-mail: helton@miscsurgeons.com Tel.: +1 312 355 1493 Fax: +1 312 355 1987 Hernia (2005) 9: 96–99 DOI 10.1007/s10029-004-0260-3