Radiological Case: Complete Gastric Transmural Migration of a Prosthetic Hiatal Hernia

Brian Berg; Ryan Cobb, MD; Kyle Panzer; Benjamin Powers, MD; Sonia Gupta, MD; Tejas Patel, MD

Disclosures

Appl Radiol. 2018;47(1) 

In This Article

Imaging Findings

Initial CT of the abdomen and pelvis without IV contrast showed diffuse inflammation at the level of the hiatal hernia repair with mesh. The prosthetic mesh was eroding through the gastric wall and partially protruding within the gastric lumen surrounded by gastric contents. No extraluminal air or fluid collection was present to suggest perforation or leakage of gastric contents into the peritoneum.

CT of the abdomen and pelvis with IV contrast after the initial EGD demonstrated protrusion of the hiatal hernia mesh into the gastric lumen. The post-procedural air, acting as negative enteric contrast, delineated the true intraluminal nature of the mesh. In addition, there is soft tissue inflammation involving the gastric fundus, gastrosplenic ligament, and gastrohepatic ligament. There was no evidence of extraluminal air or fluid collection to suggest perforation and/or spillage of gastric contents. A three-dimensional reconstruction of the gastric lumen with field-of-view projecting towards the gastroesophageal junction exhibited intraluminal mesh with preservation of the lower esophageal sphincter.

Intraoperative EGD images provided by the surgical team displayed the transmural progression of the entire mesh, which is lodged in the pylorus.

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