Infected incisional hernia revealing incidental choriocarcinoma on histopathology: A case report

Abstract

Incisional hernia repair is commonly complicated by infection and delayed wound healing, usually attributed to contamination or mesh-related factors. Rarely, persistent or atypical wounds may indicate an underlying malignancy. Choriocarcinoma is an aggressive trophoblastic tumor, with extrauterine forms being uncommon and typically metastatic. Primary involvement of the abdominal wall is exceptionally rare. We report a case of an infected incisional hernia presenting as a chronic nonhealing wound, with incidental choriocarcinoma diagnosed on histopathology. A 40-year-old woman with two prior cesarean deliveries had previously undergone a combined hysterectomy and incisional hernioplasty with onlay polypropylene mesh at another center. Her postoperative course was complicated by persistent wound infection requiring multiple debridements, but the wound failed to heal over 2 years. She later presented to us with foul-smelling discharge from the abdominal wound, for which mesh explantation and secondary closure were performed. After being lost to follow-up, she presented a year later with purulent discharge from multiple sinus tracts. Imaging revealed a large infraumbilical incisional hernia with subcutaneous fluid collection. She underwent diagnostic laparoscopy, followed by wide excision of the infected abdominal wall and reconstruction with a biological mesh. Histopathological examination (HPE) demonstrated high-grade choriocarcinoma, confirmed on immunohistochemistry. She subsequently received multiagent chemotherapy and had an uneventful recovery. Persistent or recurrent wound infection following incisional hernia repair should prompt consideration of atypical etiologies, including malignancy. Histopathological evaluation of the excised tissue in such cases is essential to avoid missed diagnoses. Early detection and a multidisciplinary approach are key to optimal outcomes.