Intraluminal migration of mesh following incisional hernia repair.

Incisional hernia is the most common long term complication of colon surgery. These hernias are often repaired with synthetic mesh. Mesh migration is an infrequent occurrence. There are reports of mesh migrating into the peritoneum and into viscous organs causing a variety of symptoms including recurrent hernia, infection, and obstruction. We present the case of transmural mesh migration from the abdominal wall into the small bowel presenting as small bowel obstruction.

Failure of medical treatment in an adult cystic fibrosis patient with meconium ileus equivalent.

Meconium ileus equivalent is one of the lesser-known manifestations of cystic fibrosis. It manifests as distant small bowel obstruction caused by meconium-like stool plugs and occurs mostly in adult patients. With the improved overall survival of patients with cystic fibrosis, general surgeons may encounter this condition more often in the future. We treated a 19-year-old woman with cystic fibrosis who presented with complete distal small bowel obstruction. Medical therapy with Gastrografin and N-acetylcysteine failed to resolve the obstruction. At surgery, a meconium-like plug in the distal ileum was manually pushed into the colon with subsequent relief of symptoms. Meconium ileus equivalent should be considered and treated in cystic fibrosis patients presenting with small bowel obstruction.