There have been few cases of composite mesh migration reported in the literature, although the patients have been symptomatic in every instance, with a complication such as enterocutaneous fistula, bowel obstruction, or intra-abdominal mass formation [
3,
5,
6]. To our knowledge, this is the first report of a composite mesh migration without causing symptoms or signs. Herrera
et al. reported the first case of mesh migration following incisional hernia repair [
7]. A foreign body laying inside the peritoneal cavity has the tendency to migrate into bowel or through the skin into the exterior. Composite meshes were designed to eliminate this by having a more porous nonabsorbable surface facing anteriorly to allow ingrowth of connective tissue while the inert surface made of an absorbable material faces inside, preventing adhesions [
2]. The migration process may occur either acutely due to a postoperative inflammatory process or as a slow process [
8]. It is possible that the initial event in our patient was the dislodgment of the mesh from the anchoring sutures. Several small bowel loops could have adhered to the exposed polypropylene surface, and slow erosion into a loop would have started. The initial necrosis of the bowel wall due to the inflammation would have been sealed off by the surrounding bowel loops, preventing an abscess formation. Once the mesh was slowly internalized, it is possible that the opening would simultaneously have been sealed off by the bowel loops; hence, the bowel mass detected during this laparotomy would have formed. Similar silent erosion by a retained surgical sponge has been reported [
9]. A slow process is likely to cause foreign body migration without leakage of content, but, given the size of the extracted mesh, it is highly likely to cause a fistulous tract. Soler
et al. reported one case of composite mesh migration into the small bowel under experimental conditions in a murine study [
10]. Mesh migration to different parts of the intestine in humans has been reported [
3,
7,
11,
12]. In all cases, the patients were symptomatic due to sepsis or obstruction. The uniqueness of our patient’s case is that at no stage during the preceding 4 years had the patient experienced such a complication. The staging computed tomography (CT) performed in this patient did not reveal the presence of a mesh in the small bowel. The literature also indicates similar failures of CT scans to detect the presence of a mesh inside the bowel [
3].