Case study: When you hear from the mesh injured every day, it is hard to read the cold and optimistic medical journals describing the unspeakable horrors of mesh injuries in unemotional terms–seemingly without much concern about how the victim can go on with her life. The story of a 41-year-old woman demonstrates how an undiscovered surgical bowel injury can cause serious illness:
The woman went to her surgeon complaining about a prolapsed rectum and was implanted with a posterior mesh kit (e.g. Monarc Subfascial Hammock). Immediately, she felt severe pain radiating down her right leg, pelvic pain, pain during intercourse, dyschezia (painful defecation), diarrhea, and rectal incontinence that she had never had before. When her surgeon examined her vagina he could feel she had tight, tender mesh arms palpable at the top of her vagina. When he examined her rectum he found a stretch of the mesh had been placed about 3 inches up and inside and across her rectum(!). Further tests pointed to a rectovaginal fistula and inflammation that involved her right sciatic nerve plexus. She then underwent an abdominal surgery where removed they the mesh, fixed two perforations in her rectum and created an ileostomy (hole in her abdomen to drain feces into a plastic bag) to allow her rectum time to rest and heal. Her pain lessened and later surgeons reconnected her intestine and closed her ileosotomy. Her other symptoms reportedly got better as well.
Somehow, this report missed the shame and agony this woman was put through by a very shoddy surgical procedure. One can only imagine what she went through as she tried to maintain her life as a 41-year-old woman.
Bowel injuries from pelvic mesh involve actual puncture of the bowel during insertion or tissue injury that results in a perforation down the line–sometimes much later. Skilled surgeons try to avoid perforating the bowel although sometimes it is unavoidable. They must visualize and recheck the bowel before closing the wound to make sure it hasn’t been cut. Heightening the risk of cutting is the use of a trocar (see Bladder Injuries), to insert the pelvic mesh without being able to see where it is going. If he/she repairs a cut immediately, there is minimal risk of post-operative complications. All too frequently, a nick in the bowel is missed, especially during the blind procedure that is required to implant pelvic mesh. Missed bowel injuries are severe complications which can lead to life-threatening illness—even death.
During the post-operative period, surgeons need to respond quickly to signs and symptoms of bowel perforation. After bowel injury a patient’s symptoms may include pain, fever, rapid heartbeat, and rapid breathing or the patient is rapidly declining. Signs of life-threatening bowel perforation include abdominal distention, rebound tenderness (pain only when pressure on abdomen is quickly released), and a rigid abdomen.
The leakage of bowel contents (which are very high in bacteria) into the abdominal cavity usually results in peritonitis, inflammation of the lining of the abdomen, along with inflammation of the tissues of the bowel and other abdominal organs. If the surgeon diagnoses the problem quickly, he may be able to repair the injury without performing a bowel diversion, such as an ileostomy or colostomy. Delay in diagnosis, however, often results in development of severe inflammation that makes the bowel tissue so fragile that the surgeon can’t perform a single, definitive repair. Depending on the extent of bowel injury and the patient’s health, the ileostomy or colostomy may be reversed at a later date or may be required for the rest of her life.
If you suspect you have a bowel injury, seek immediate medical attention. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Peggy Day is working on a book to combine all these stories. This is an excerpt from Pelvis in Flames: Your Pelvic Mesh Owner’s Guide. Your input is welcome to help make Pelvis in Flames the book you need to read.
If you’d like to join an online support group and learn about erosion, partial removals, surgeons, or just find out that you are not alone, join my group, Surgical Mesh or check the list of support groups here.
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