Inguinoscrotal herniation of the bladder: A rare case of obstructive uropathy

A Rare Case of Giant Inguinoscrotal Bladder Hernia as a Cause of Acute Respiratory Distress Syndrome

An inguinoscrotal hernia is a common condition in medical practice. However, an inguinoscrotal hernia involving the urinary bladder is a rare entity that can easily lead to diagnostic errors, resulting in inappropriate medical management. We report the case of a 77-year-old patient who presented to the emergency department with dysuria and testicular pain persisting for over a year. Clinical examination revealed a large, non-reducible inguinoscrotal hernia on palpation. Abdominopelvic computed tomography demonstrated a giant inguinoscrotal hernia containing almost the entire bladder, causing post-renal obstruction with upstream uretero-hydronephrosis. Emergency surgery was scheduled, involving inguinoscrotal hernia repair using the Lichtenstein technique. Postoperatively, the patient developed septic shock of urinary origin, complicated by severe acute respiratory distress syndrome (ARDS).

Incarcerated inguinal hernia containing urinary bladder and bladder calculi

Inguinoscrotal herniation of the bladder is an uncommon condition. Clinicians should have a high index of suspicion for involvement of the bladder within a hernia when the lower urinary tract urinary symptoms are concurrently present in patients presenting with a painful groin lump. We report the case of a patient who presented with an inguinoscrotal hernia involving the urinary bladder, which was irreducible due to the fact that the herniated portion of the bladder contains multiple containing calculi. The patient underwent successful operative repair of the hernia and had an uncomplicated post-operative course. Key takeaway messages for clinicians are that the presence of lower urinary tract symptoms in a patient concurrently presenting with a groin lump should raise suspicion of bladder involvement within the hernia and that pre-operative imaging is valuable to identify the contents of the hernia to allow safe operative planning and to reduce the risk of bladder injury during surgery.