Urinary bladder-containing incarcerated inguinoscrotal hernia: a case report

Abstract

Inguinoscrotal hernia containing the urinary bladder is a rare entity found in 1–4% of inguinal hernias, while patients rarely present symptoms of urinary dysfunction. We present the case of a 79-year-old Caucasian male with acute renal dysfunction and incarcerated inguinoscrotal hernia containing the entire urinary bladder. The patient presented in the surgical emergency department due to an incarcerated right inguinoscrotal hernia and deteriorated renal function. Preoperatively, ultrasound imaging was performed, which showed the presence of the whole bladder in the hernia sac. The bladder was repositioned to its anatomic position and hernia was repaired through a modified Lichtenstein technique. In patients with inguinoscrotal hernia and acute urinary tract symptoms, surgeons should be aware of the possibility of inguinal bladder hernia. Preoperative imaging can help in preventing intraoperative bladder damage.

Inguinal Bladder Hernia (IBH) managed by Lichtenstein technique: A case report

“…Several factors contribute to a higher incidence of this condition including advanced age, obesity, medical history such as an open appendectomy surgical intervention, benign prostatic hypertrophy, Bladder outlet obstruction (BOO), and gender [6] ; statistics show that there is a ten-fold increase in male when compared to female incidence [4] . Our patient represents a typical example, he is an obese male aged 40 years old with a BMI of 34.06 kg/m 2 .…”

“…Though voiding cystourethrography is the best diagnostic technique for IBHs demonstrating a dog ear herniation of the bladder, the US is assumed as the foremost option to take because it is low-cost and affordable when compared to other methods, showing a hypoechogenic mass extending through the inguinal canal from the urinary bladder to the scrotum [6] . Whereas computed tomography scan (CT) is considered to be more effective and highly recommended in old male patients with high BMI suffering from LUTS, it demonstrates a “Micky mouse sing” in the presence of bilateral bladder hernia [6] . Because of the cystoscopic appearance of IBHs, it may be sometimes wrongly diagnosed as a bladder diverticulum.…”

“…Inguinal bladder hernias can be treated either by reducing the protruding bladder to its anatomical position or by resecting the partial bladder [6] . Bladder resection is decided under special conditions such as the small diameter of the hernia's neck (<5 mm), and the presence of bladder necrosis, neoplasm, and a true bladder diverticulum [6] . After both bladder resection and reduction, herniorrhaphy (hernia repair) is performed through several techniques like Bassini, Mac way, and Lichtenstein [9] .…”

Kirkšninė Šlapimo Pūslės Išvarža: Klinikinis Atvejis

“…Tam tikrais atvejais naudinga atlikti cistoskopiją -prostatos hiperplazijai bei žymiai hematurijai įvertinti [11]. Kompiuterinės tomografijos tyrimą tikslingiausia atlikti nutukusiems, vyresniems nei 50 metų vyrams, turintiems šlapinimosi sutrikimų [12]. Nenustačius diagnozės prieš operaciją, šlapimo pūslės išvarža gali būti nustatoma operacijos metu, dažniausiai dėl jatrogeninio sužalojimo (maždaug 12 % šlapimo pūslės išvaržų atvejų), arba dėl komplikacijų po operacijos [13].…”

“…Nenustačius diagnozės prieš operaciją, šlapimo pūslės išvarža gali būti nustatoma operacijos metu, dažniausiai dėl jatrogeninio sužalojimo (maždaug 12 % šlapimo pūslės išvaržų atvejų), arba dėl komplikacijų po operacijos [13]. Priešoperacinė diagnostika yra itin svarbi, siekiant išvengti tolimesnio šlapimtakio sužalojimo ar perrišimo, nes tai gali sukelti grėsmingas pooperacines komplikacijas, tokias kaip sepsis, ryški hematurija ir fistulių susidarymas [12]. Pabrėžtina, jog atvejais, kai išvaržos vartų skersmuo yra mažesnis nei 5 cm, yra šlapimo pūslės sienelės nekrozė, perforacija, divertikulas, ar kai nustatomas šlapimo pūslės navikas, indikuotina atlikti dalinę šlapimo pūslės rezekciją [14].…”