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A middle-aged patient presented to the emergency department with severe pain in the right groin. 2 days ago, he had a “throwing” sensation in his right groin while lifting heavy objects at work. At this time, his pain was compounded by swelling of the ipsilateral testis and scrotum. He denied fever, nausea, vomiting, diarrhea, or constipation. There was a history of bilateral inguinal hernia, of which only the left one was repaired 2 years ago. The patient did not have an inguinal hernia on the right side; however, it has been asymptomatic all this time. Vital signs on admission were within normal limits. The patient had mild discomfort due to pain in the right subclavian region. Her abdomen was soft, not tender or distended. A genitourinary examination revealed a marked swelling of the right testicle with tenderness to light touch. An integral part of the testicular mass appeared on the right testicle. The patient had no tenderness in the inguinal ring, with most of the pain located above the epididymis. Laboratory tests were within normal limits, except for leukocytosis (13.5×10
Hernia Of The Urinary Bladder
(10–50 000 CFU/ml). Testicular ultrasound showed normal vascular flow without evidence of tortuosity with an enlarged right epididymis and varicocele. On ultrasound, there was no bowel in the testicle. Follow-up abdominal CT scan with intravenous contrast revealed a fat-containing right inguinal hernia and a right hemicarcinoma extending to the right anterior corner of the bladder without bowel involvement (Figures 1 and 2). A urethral catheter was placed to depress the bladder and intravenous antibiotics for epididymitis were started. The next morning, the patient reported improvement in his symptoms and was subsequently discharged. 3 weeks later, she underwent elective hernia repair.
Laparoscopic Repair Of Large Bladder Herniation Presenting As An Inguinal Hernia
Axial CT of the abdomen and pelvis shows herniation of the bladder into the right inguinal canal (yellow arrows).
Coronal CT of the abdomen and pelvis shows a herniated bladder into the right inguinal canal (yellow arrows).
Bladder inguinal hernia (PMH) is a rare condition first described by Lewin in 1951 as a cystocele. Bladder involvement occurs in 1-4% of inguinal hernia cases in the general population and in men over the age of 50. approaching 10%.1 Bladder hernia is caused by an acquired abdominal defect, classifying it as a rectus inguinal hernia, and thus increases in frequency with age. Most patients are diagnosed incidentally on imaging or herniation because of the sliding nature of these hernias.1 BPH can present with recurrent perineal swelling and urinary tract infection (UTI).1 However, inguinal and spinal bladder obstruction is possible. Interestingly, in these cases, the patient completes emptying in two stages. voiding first, followed by spinal contraction to empty the bladder completely. An overview of Oruch
3 revealed an incidence of genitourinary malignancy of 11% (13/116 cases) in patients with IBD. Less than 7% of VCRs are diagnosed before herniation, 16% are diagnosed due to postoperative complications (bladder leakage), and the rest are diagnosed intraoperatively. . Men over 50. In these cases, the contents of the inguinal hernia should be confirmed by computed tomography before hernia repair.2 This may avoid surgical complications, including bladder injury, which occurs in 12% of Hernia-resolvable hernias in VHC, and allows for a modification of the surgical approach. :1,2 Treatment for IBG remains the same as for any inguinal hernia. During herniation, the bladder is identified and lowered to its original position. 1 Alternatively, patients can be managed conservatively with urethral catheterization to decompress and decompress the bladder, as in this patient. A 77-year-old man with benign prostatic hypertrophy (BPH) was admitted to our hospital in 2011. in October with a history of right groin swelling for several months. He was otherwise asymptomatic. Physical examination revealed a right inguinal hernia. Perineal ultrasound (US) showed a fluid-filled lesion in the right testicle. It had the appearance of a beak in the skull, which could be observed in the right inguinal canal (Fig. 1a). A small calcified focus was observed in this fluid-filled structure (Fig. 1b). The normal right testis was displaced downward (Fig. 1c). The results show an inguinal hernia of the bladder with a bladder stone. This was confirmed by noncontrast computed tomography of the abdomen and pelvis, which showed a herniated bladder along the inguinal canal and into the right testis with a small bladder stone (Fig. 2).
Definitely Not Just Another Hernia
Figure 1. (a) Ultrasonography shows a fluid-filled, beaked structure in the right scrotum. (b) A small calcified focus is seen within a fluid-filled structure in the right scrotum (white arrow). (c) The normal right testis is displaced downward by a fluid-filled structure (black arrow).
Figure 2. (a) Non-contrast computed tomography (CT) of the abdomen and pelvis on a resected image shows herniation of the bladder into the right testis (arrow). (b) Axial noncontrast CT shows a herniated bladder into the right testis (arrow) with a small stone in the bladder (arrow).
Bladder hernia is a rare disease that occurs in 1-4% of inguinal hernias. However, the incidence increases to approximately 10% over the age of 50 years.1 Most patients are asymptomatic and are usually discovered incidentally during inguinal hernia repair or even hernia repair. Sometimes patients may complain of urinary symptoms, especially in the advanced stage, and may induce biphasic voiding, i.e. manual compression of the testicle to completely empty the bladder. Predisposing factors include obesity, bladder outlet obstruction (eg, due to BPH), and weakened abdominal muscles. Standard treatment includes surgical treatment. It is important to be aware of this diagnosis because, in addition to complications such as urinary tract obstruction, urinary tract infection, and bladder infarction, an unrecognized hernia can lead to bladder damage.1 3
1. Bisharat M, O’Donnell ME, Thompson T, et al. Complications of inguinal-scrotal hernia of the bladder. series of cases. Hernia 2009; 13:81-4. CrossRef:
Diseases Of Cattle, Sheep, Goats And Swine. Veterinary Medicine. Diseases Of The Urinary Apparatus. 503 Ureter; Its State Of Dilatation Can Be Felt, And The Existence Of Diverticula Ot Inflammation, If
2. Vindlacheruvu RR, Zayyan K, Burgess NA, Wharton SB, Dunn DC. Wide bladder infarct with strangulated inguinal hernia. Br J Urol 1996; 77: 926-7. CrossRef:
3. Oruç MT, Akbulut Z, Ozozan O, Coşkun F. Urological results of inguinal hernias. case report and literature review. Hernia 2004; 8:76-9. CrossRef:
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