1. Clinical data The patient was 31 years old, more than 3 months after the second cesarean section, and was first admitted to the hospital on July 19, 2009 with recurrent abdominal wall incision dehiscence for 2 months. She had a history of cesarean delivery for 6 years, and was discharged from the hospital 5 days after surgery due to a local lower uterine cesarean section with a scarred uterus, with a grade A healing incision. The diagnosis was: fat liquefaction of the incision of the abdominal wall, after the application of antibiotics and local changes to remove the silk knots, the ooze was reduced and a second suture was performed under local anesthesia, and the stitches were removed in 8 days. The abdominal wall and pelvic ultrasound was performed: tunnel-like hypoechogenicity was seen from the abdominal wall to the uterus, dilute melanin solution was injected into the fistula hole, the gauze in the vagina was blue stained, the diagnosis was: uterine abdominal wall fistula, an exploratory dissection was performed, intraoperative thickening of the anterior sheath of the rectus abdominis muscle, extensive dense adhesions of the wall peritoneum, greater omentum, bladder anterior wall of the uterus, sinus tract curved, 0.5-1 cm in diameter, the bottom of the sinus tract was the lower uterine incision, it was “The uterus was trimmed of necrotic tissue and the remaining uterine tissue was not easily shaped, so a subtotal hysterectomy with preservation of the superior branch of the uterine artery + abdominal wall sinus resection was performed. The postoperative abdominal wall was drained by rubber strips for 48h, and the stitches were removed and discharged in 10 days, with no abnormality in 2 months of follow-up. 2, discussion Uterine abdominal wall fistula after cesarean section is rare clinically, the lower uterine incision is the basis of morbidity, incisional dehiscence is related to the following factors ① improper selection of uterine incision location ② poor healing of secondary surgical scar tissue ③ poor suture technique ④ puerperal infection; clinical manifestations are mainly late postpartum hemorrhage, abdominal wall incision repeatedly dehiscent, delayed; B ultrasound, melan test can be done to assist in the diagnosis; the disease needs to be associated with abdominal wall The treatment principle is surgical excision of sinus tracts and lesions, preoperative iodine oil or pantothenic glucosamine imaging to clarify the sinus tract pathway, depth, basal size and relationship with other parts; intraoperative sinus tract Melan staining to prevent leakage at the branches, uterine lesion treatment: small necrotic tissue, light inflammatory response, local debridement suture, internal iliac artery, and If the extent of necrotic tissue is small and the inflammatory response is mild, local debridement and suturing, ligation of the internal iliac artery, or embolization of the internal iliac artery can be done to preserve the patient’s fertility and endocrine function; if the extent of tissue necrosis is large, subtotal hysterectomy or total hysterectomy is feasible. Savitskii has reported successful re-pregnancy and delivery after pouch suturing of the lesion. In this case, a subtotal hysterectomy with preservation of the superior branch of the uterine artery was performed, preserving the blood supply to the ovaries, with less impact on pelvic floor function and stability, and with good results. The shortcoming of this case is the lack of awareness of the disease until the diagnosis of menstrual reflux was confirmed.