Obturator hernia: the ‘little old lady's hernia’

a better ‘landing zone’ for the underlying flat part of the funnel mesh. The DynameshTM, IPST implant (FEG Textiltechnik, Aachen, Germany) is a 3-D preshaped, specially designed macroporous (>1 mm) and monofilament mesh, consisting of visceral-sided polyvinylidene fluoride and parietal-sided polypropylene. To provide magnetic resonance (MR) visibility, tiny iron particles (Fe3O4 iron load of 10 mg/g polymer) have been embedded into the dark filaments of the base material and lead to local magnetic gradients between mesh and surrounding tissue (arrow on Fig. 2). On postoperative day 6, the patient underwent MR imaging on a 1.5 Tesla scanner (SiemensTM Symphony Tim) using T1-weighted multi-shot gradient echo sequences and turbo spin echo sequences. By using the 2-D-gradient echo sequences-T1 flash sequence, the mesh implant can be delineated as hypointense susceptibility artefacts, visible as a distinct line of signal voids against hyperintense surrounding structures. The mesh is depicted as a black structure because of its lack of water signals and the contrast to surrounding muscle or fatty tissue is clear (arrows on Fig. 3). Turbo spin echo sequences-T2-blade sequences cannot provide accurate mesh depiction, which is figured as faint dotted line but the surrounding anatomy is well shown. This case demonstrates that 3-D meshes are suitable either for parastomal hernia prevention and treatment. In vivo MR visualization is satisfactorily possible.