Vesicocutaneous Fistula Secondary to Mesh-plug Herniorrhaphy for Bladder Hernia

Abstract

We report the case of a 76-year-old male patient who had an anamnesis of a recurring internal right inguinal hernia containing the bladder, for which he underwent mesh-plug repair 7 years prior to his presentation at our department. Six years later, the surgical wound began to discharge pus, and mesh infection and vesicocutaneous fistula were diagnosed after careful examination. As conservative therapy was ineffective, we decided to perform surgery. We removed the skin and mesh that contained the fistula and then excised a portion of the fistulated bladder. Before closure, we ensured that the plug tip had penetrated the bladder. We sutured the bladder wound and performed iliopubic tract repair of the hernia. The patient made good progress after the operation. Mesh infection after inguinal hernia repair is often not improved by conservative medical management and requires removal of the mesh. Inguinal hernia containing the bladder is sometimes called bladder hernia. From the viewpoint of operative findings, we suggest that indwelling of the plug tip directly in the bladder wall caused the bladder fistula formation in the present case. When the mesh-plug method is used for the treatment of bladder hernia, surgeons must pay attention to the possibility of vesicocutaneous fistula formation.