Giant squamous cell carcinoma developed on a mesh-related enterocutaneous fistula: A case report

INTRODUCTION: Squamous cell carcinoma degeneration on enterocutaneous fistulas (EF) is infrequent. There are some reports of malignant conversion in Crohn's disease-associated fistulas. Literature about the malignant development of mesh-related EF is even more limited. PRESENTATION OF THE CASE: A 66-year-old patient who developed necrotizing pancreatitis was managed through an open necrosectomy approach with a prolonged open abdomen that derived an incisional hernia which was repaired using a synthetic mesh. Years later, the patient was admitted to the service because of hypovolemic shock due to gastrointestinal bleeding. An abdominal wound with mesh exposition and cloudy discharge was observed. A high-output enterocutaneous fistula diagnosis was established. After an institutional surgical committee, a surgical approach was defined, a 60 cm en-block resection of the involved small bowel was done, and the surgical specimen was obtained for histopathological analysis. DISCUSSION: The use of prosthetic mesh in the case of incisional hernias is associated with a higher incidence of complications. However, there is no evidence of the development of squamous cell carcinoma developed on a mesh-related enterocutaneous fistula. This is a condition associated with Chron's disease and its diagnosis should be suspected by the exacerbation of local signs and symptoms. The scarce literature published suggests that this pathology can be managed by radical surgery and even chemoradiation, the last one required only for patients with associated Chron's disease. CONCLUSION: Squamous Cell Carcinoma developed on a mesh-related enterocutaneous fistula is a rare condition with no classic signs and symptoms that allow diagnostic identification.