Unexpected intraoperative discovery of multiple metallic screw-fixed anterior abdominal wall mesh during open myomectomy: A case report

Metallic screw-fixed mesh

Abstract

Mesh repair is the standard approach for anterior abdominal wall hernias because it provides durable reinforcement and low recurrence rates. Over time, fixation techniques have evolved toward safer and less invasive methods, and metallic screw fixation has largely become obsolete. Nevertheless, older fixation techniques may still be encountered and may complicate subsequent abdominal or pelvic surgery. We report the case of a 37-year-old woman with a history of two prior cesarean sections and hernia repair with mesh fixation 11 years earlier. She presented with pelvic pain, pelvic heaviness, and abnormal uterine bleeding. Ultrasonography revealed a large posterior cervical wall leiomyoma. During open myomectomy, multiple metallic screws securing the anterior abdominal wall mesh were unexpectedly identified, requiring careful dissection, adhesiolysis, and modification of the abdominal entry technique to safely access the peritoneal cavity. The procedure was completed without complications, and the patient recovered uneventfully. This case highlights the importance of obtaining a detailed surgical history, recognizing outdated fixation techniques, using preoperative imaging when appropriate, and performing meticulous intraoperative planning to minimize risk during reoperative abdominal and gynecologic surgery.

Case Presentation: A 37-year-old woman with a history of two cesarean sections underwent hernia repair with mesh fixation 11 years earlier. She later developed pelvic pain, a sensation of heaviness, and abnormal uterine bleeding. Ultrasonography confirmed a posterior cervical wall leiomyoma. During open myomectomy, multiple metallic screws were unexpectedly discovered securing the anterior rectus sheath mesh. The mesh was incised carefully, and extensive omental and uterovesical adhesions were released. Myomectomy was then completed through a posterior uterine wall incision, followed by standard closure. The patient recovered uneventfully.

Conclusion: This case emphasizes the importance of recognizing obsolete mesh fixation techniques, such as metallic screw fixation, which can complicate reoperative abdominal or pelvic surgery. Detailed surgical history and preoperative imaging are vital for proper operative planning and minimizing surgeon and patient intraoperative complications.