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{
    "pk": 1085,
    "title": "Enterocutaneous Fistula and Abscess Diagnosed with Point-of-care Ultrasound",
    "subtitle": null,
    "abstract": "Case Presentation:\n A 64-year-old female with history of umbilical hernia repair with mesh 18 years prior, cystocele, and diabetes mellitus presented with 10 days of abdominal and flank pain.  The patient was tachycardic, normotensive, afebrile, and had an erythematous, tender, protuberant abdominal wall mass. Point-of-care ultrasound (POCUS) revealed an irregular, heterogeneous extraperitoneal fluid collection with intraperitoneal communication; these findings were consistent with an abscess and infected mesh with evidence for intraperitoneal extension.  The diagnosis of enterocutaneous fistula (ECF) with infected mesh and abdominal wall abscess was confirmed with computed tomography and the patient was admitted for antibiotics and source control.\nDiscussion: \nA rare complication of hernia repair with mesh, ECF typically occurs later than more common complications including cellulitis, hernia recurrence, and bowel obstruction. In the emergency department, POCUS is commonly used to evaluate for abscess; in other settings, comprehensive ultrasound is used to evaluate for complications after hernia repair with mesh. However, to date there is no literature reporting POCUS diagnosis of ECF or mesh infection. This case suggests that distant surgery should not preclude consideration of mesh infection and ECF, and that POCUS may be useful in evaluating for these complications.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "ultrasound"
        },
        {
            "word": "fistula"
        },
        {
            "word": "hernia repair"
        }
    ],
    "section": "Images in Emergency Medicine",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/18s8d9fj",
    "frozenauthors": [
        {
            "first_name": "Sarah",
            "middle_name": "",
            "last_name": "McCuskee",
            "name_suffix": "",
            "institution": "New York University School of Medicine, Department of Emergency Medicine, New York, New York",
            "department": "None"
        },
        {
            "first_name": "Kenton",
            "middle_name": "L.",
            "last_name": "Anderson",
            "name_suffix": "",
            "institution": "Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California",
            "department": "None"
        }
    ],
    "date_submitted": "2021-10-06T01:55:26Z",
    "date_accepted": "2021-10-06T01:55:26Z",
    "date_published": "2021-10-06T01:57:11Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/1085/galley/827/download/"
        }
    ]
}