Invasive Candida albicans fungal infection requiring explantation of a noncrosslinked porcine derived biologic mesh: a rare but catastrophic complication in abdominal wall reconstruction

Invasive Candida albicans fungal infection requiring explantation of a noncrosslinked porcine derived biologic mesh: a rare but catastrophic complication in abdominal wall reconstruction

Can J Surg 2020;63(6):E533-E536 | PDF

Isha Ober, BN, BSc; Duncan Nickerson, MD; Mara Caragea, MD; Chad G. Ball, MD; Andrew W. Kirkpatrick, MD, MHSC

Summary

Biologic mesh is preferred over synthetic mesh for complex and contaminated abdominal wall repairs; however, there are very little data on the risks and complications associated with its use. We report the case of a 67-year-old man with failed synthetic mesh repair for recurrent ventral hernia, who subsequently required an abdominal wall reconstruction (AWR), including the intraperitoneal sublay of noncrosslinked biologic mesh. His postoperative course was complicated with catastrophic sepsis and sustained hemodynamic instability, responding only to mesh explantation. The biologic mesh was subsequently noted to be histologically infected with invasive Candida albicans. Although noncrosslinked biologic mesh is a valuable adjunct to AWR, it is not infection-resistant. Although it is rare, infection of any foreign tissue, including biologic mesh, can occur in the setting of complex ventral abdominal wall repairs. Clinicians should be watchful for such infections in complex repairs as they may require biologic mesh explantation for clinical recovery.


Accepted January 7, 2020

Affiliations: From the University of Calgary, Cumming School of Medicine, Calgary, Alta. (Ober, Nickerson, Caragea, Ball, Kirkpatrick); the Department of Surgery, University of Calgary, Calgary, Alta. (Nickerson, Ball, Kirkpatrick); the Department of Pathology, University of Calgary, Calgary, Alta. (Caragea); and the Department of Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick).

Competing interests: C.G. Ball is coeditor-in-chief of CJS. He was not involved in the review or decision to accept this manuscript for publication. No other competing interests were declared.

Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.

DOI: 10.1503/cjs.015619

Correspondence to: A.W. Kirkpatrick, Regional Trauma Services, EG 23, Foothills Medical Centre, 1403 29 St NW, Calgary AB T2N 2T9, andrew.kirkpatrick@ahs.ca