Case 1: A male patient underwent open hernia repair 13 years ago for right oblique inguinal hernia; Laparoscopic right inguinal hernia repair (anti-adhesive patch, laparoscopic stapler nailing and fixation) for hernia recurrence 9 years ago; Five years ago, open hernia repair was repeated (part of the original patch was removed and repaired with a new polypropylene patch); Partial resection and anastomosis of small intestine due to ileovesical fistula 2 years ago, and the urinary catheter was preserved for 3 weeks after operation; Abscess in the right inguinal area appeared 3 months ago, and the anti-infection effect was not good. Abscess incision and drainage were performed, and the wound did not heal for a long time after operation. After the visit to our hospital, the physical examination showed that the incision about 3 cm long in the right inguinal area was not healed, with gray discharge and obvious fishy smell (Figure 1). Abdominal sinus tract angiography showed intestinal and bladder development, suggesting intestinal bladder fistula (Figure 2). After intravesical infusion of methylene blue saline, blue fluid was seen exudating from the wound sinus tract, confirming the abdominal wall bladder fistula (Figure 3). The results of bacterial culture in wound pus suggested that Escherichia coli was positive, and sensitive antibiotics were given to treat. Based on the results of the patient's medical history, physical examination and auxiliary examination, the diagnosis of right inguinal hernia after operation, patch infection, ileal fistula and bladder fistula was clear. Then under general anesthesia, laparoscopic abdominal sinus tract expansion, infected patch removal, damaged intestinal wall and bladder wall repair were performed. Intraoperative exploration showed an old anti-adhesion patch and spiral metal nail. The patch eroded the terminal ileum, and an ileal fistula with a diameter of 1 cm was visible. There was more purulent secretion before the patch. The infected patch and metal nail were completely removed after surgery (Figure 4). The preperitoneal space was opened in the direction of the abscess cavity, about 50 ml of pus was aspirated, and the other infected patch was completely removed. Ileal fistula was repaired by suture, but no clear bladder fistula was found. The surgical area was flushed with a large amount of normal saline, and one abdominal cavity and one anterior peritoneal drainage tube were placed. After closing each poke, the poorly healed wound was resected in a fusiform shape, the infected sinus tract of the abdominal wall was completely removed layer by layer downward, the residual patch and necrotic tissue were completely removed, and the wound was intermittently sutured in full thickness. Symptomatic and supportive treatment such as anti-inflammatory and parenteral nutrition were given after operation. Exhaust on the second day after operation, defecation and fluid food on the third day, and discharge after suture removal and drainage tube removal on the 10th day. The catheter was removed after urological evaluation 1 month after operation, and the recovery was good after 6 months after operation.
