Purpose To investigate the adoption of multidetector computed tomography (CT) for the diagnosis of the abdominal wall infection involving mesh post various ventral hernia repairs with mesh.

The total 23 cases of suspected abdominal wall infection after various ventral hernia repairs with mesh implantation were retrospectively studied, including 12 cases of inguinal hernioplasty with Mesh-plug (MP), 2 cases of Lichtenstein, 1 case of TAPP and 3 cases of TEP for inguinal hernia; and 2 cases of Onlay, 1 case of Underlay and 2 cases of IPOM for incisional hernia. For all cases, abdominal CT scan was employed prior to operation. For chronic infections with sinus in the infection site, contrast agent was injected into the sinus 30 minutes before CT scan. For the patients to undergo operation for the removal of the infected meshes, methylene blue was injected into the sinus at the beginning of operation. The diagnosis of mesh infection was established when the pus collection detected, mesh stained with methylene blue and/or mesh not integrated into the surrounding tissue during the operation exploring the infected site.

For 16 cases of chronic abdominal wall infection with sinus radiography, only 1 case with contrast agent just developing limited to the subcutaneous layer instead of permeating into the deeper area while the rest 15 cases with contrast agent developing deep into where the mesh infection occurred. For the above-mentioned 16 cases with methylene blue injection, both sinus and infected mesh were stained in 13 cases. For 5 cases of chronic infection without sinus, deep infection sites were all identified on CT, of which one case of post muscular abscess formation with polypropylene mesh identified in the abscess cavity. For 2 cases of acute infection after inguinal hernia repair, CT scan showed the image development of infected areas involving mesh in the process of treatment; with one case of infection post bilateral inguinal hernia MP repair, infected mesh was found to be surrounded by pus when converted to operation after non-operative management failed on one side.

CT scan (with sinus radiography if permitted) is an effective method for the diagnosis of abdominal wall infection involving mesh post ventral hernia repair with mesh and so provide the evidence for choice of treatment as concerns about mesh removal or not.