Infected left arm of transvaginal tape

Case contributed by Dr Mark Hall

Presentation

Exposed TVT-O® mesh - suburethral with sinus tract seen particularly on the left side - foul-smelling discharge. MRI scan to rule out any extension of tracts into groin.

Patient Data

Age: 55 years
Gender: Female
MRI

MRI Pelvis (Gyn)

There is thickening and increased T2 and STIR signal involving the left anterior vaginal wall in proximity to the mesh and extending laterally as a track through the left levator muscle to the left obturator internus muscle which demonstrates localized high signal. There is no evidence of extension beyond the obturator muscle into the groin. No associated collection. No contralateral abnormality.

The uterus is atrophic. No myometrial abnormality. There is focal distension of the endometrial cavity in the left cornua where there appears to be a 0.8cm rounded heterogeneous T2 high signal mass. Morphology favors a small endometrial polyp over a submucosal fibroid. The endometrium is otherwise thin and smooth.

Annotated image

Arrowed images show the tract through the left levator muscle to the obturator muscle.

Case Discussion

The patient's inflammatory markers continued to rise despite antibiotics.  They were subsequently taken to theater where the diagnosis was confirmed and they underwent total excision of transobturator tape and vaginal and bilateral groin dissection.

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Case information

rID: 72256
Published: 20th Nov 2019
Last edited: 21st Nov 2019
System: Gynaecology
Inclusion in quiz mode: Included
Institution: Queen Elizabeth University Hospital