Massive bladder hernia: ultrasonographic imaging in two cases

Rare giant inguinal hernia causing end-stage dialysis-dependent renal failure

A 72-year-old man presented with urinary retention, weight loss, haematuria and severe acute kidney injury. He had never before been admitted to hospital and his past medical history included only an inguinal hernia. On examination, he appeared uraemic and had a right-sided painful hernia. A three-way catheter was inserted, bladder washouts performed and irrigation started. An ultrasound showed severe bilateral hydronephrosis and a ‘thickened bladder’ and this was thought to be obstructive uropathy secondary to bladder cancer. Twenty-four hours later his hernia doubled in diameter, became incarcerated and a CT of the abdomen and pelvis showed an inguinal hernia of both bladder and bowel, with the catheter tip inside the bladder hernia. He was taken to theatres and an open mesh repair was performed with a rigid cystoscopy to assist in locating and reducing the bladder. He required intensive care and dialysis postoperatively and remains on regular dialysis following discharge.

A Rare Case of Inguinal Hernia with Complete Bladder Herniation

Involvement of the bladder in inguinal hernias is rare and occurs in less than 5% of the cases. The diagnosis and management of this condition may present a challenge to the surgeon. We present a case of an elderly gentleman who presented with a large left-sided inguinoscrotal hernia causing an obstructive uropathy which was surgically repaired. The patient made a quick postoperative recovery with complete resolution of renal function.

Scrotal Cystocele in a Sliding Left Inguinoscrotal Hernia: A Case Report and Review of Literature

Inguinoscrotal bladder herniation has a reported incidence of 1 to 4%. Although small bladder herniations are noted at the time of inguinal hernia repair, large bladder herniation into the scrotum is rare. These patients have a unique presentation of signs and symptoms. We report a case of a male patient of age 64 years who had a large inguinoscrotal hernia with bladder. He successfully underwent hernioplasty after repositioning of the bladder. Now, he is symptom-free and on follow-up.

How to cite this article: Mohan A, Srinivasan K. Scrotal Cystocele in a Sliding Left Inguinoscrotal Hernia: A Case Report and Review of Literature. Euroasian J Hepato-Gastroenterol 2017;7(1):87-88.

Scrotal Cystocele in a Sliding Left Inguinoscrotal Hernia: A Case Report and Review of Literature

Inguinoscrotal bladder herniation has a reported incidence of 1 to 4%. Although small bladder herniations are noted at the time of inguinal hernia repair, large bladder herniation into the scrotum is rare. These patients have a unique presentation of signs and symptoms. We report a case of a male patient of age 64 years who had a large inguinoscrotal hernia with bladder. He successfully underwent hernioplasty after repositioning of the bladder. Now, he is symptom-free and on follow-up.

How to cite this article:

Mohan A, Srinivasan K. Scrotal Cystocele in a Sliding Left Inguinoscrotal Hernia: A Case Report and Review of Literature. Euroasian J Hepato-Gastroenterol 2017;7(1):87-88.

Massive inguinoscrotal bladder hernia

Inguinoscrotal bladder hernias are rare, occurring in 1-4% of all inguinal hernias. Massive inguinoscrotal bladder hernias, where >50% of the bladder is found in the hernia sac are extremely rare. Patients can suffer significant morbidity from such a hernia. These include sepsis, unilateral or bilateral ureteric obstruction, renal failure and strangulation with secondary ischaemia of the bladder wall and bladder rupture. Inguinoscrotal bladder hernias are most commonly diagnosed at the time of surgery. This may lead to significant complications for the patient, particularly if undetected during surgery.

Pre surgical evaluation of scrotal cystocele by conventional radiography (cystogram)

Urinary bladder is a known content of sliding inguinal hernias but rarely presents as irreducible direct inguinal hernia. As inguinal hernia repair is commonly undertaken even at peripheral surgical centers. Cystogram a simple radiological investigation (picturesque view) is useful for pre-surgical evaluation as it can prevent iatrogenic bladder injury during inguinal hernia repair. This investigation can be performed where other radiological expertises like computerized tomography scan/magnetic resonance imaging or even ultrasound facilities are not readily available.

Bladder hernia: Multidetector computed tomography findings

Herniation of bladder in inguinal hernia is rare, with most cases diagnosed intraoperatively. Preoperative diagnosis is even rarer. We report a case of bladder as content of inguinal hernia diagnosed using multidetector computed tomography.

Inguinoscrotal bladder hernias: report of a series and review of the literature

Bladder involvement occurs in 1%-4% of cases of inguinal hernias. Among obese men aged 50 to 70, the incidence may reach 10%.1,2 The diagnosis of bladder involvement is often difficult to delineate at the time of presentation and may only become apparent at the time of herniorrhaphy. Surgical management pertaining to the approach, repair and potential need for bladder resection may challenge the surgeon. We report a series of 4 cases of large inguinoscrotal bladder hernias and provide a literature review. Our goal is to highlight the clinical presentation and the decisive issues surrounding the diagnosis and management of this condition.

Incidentally detected inguinoscrotal bladder hernia

The bladder is involved in less than 4% of inguinal hernias. Inguinoscrotal bladder hernias are difficult to diagnose, and less than 7% are diagnosed preoperatively. Inguinoscrotal bladder hernias are usually asymptomatic. However, they can result in significant complications, such as bladder necrosis or acute renal failure. Accurate diagnosis is crucial to avoid bladder injury during surgery and other complications. Here we report the case of a 64-year-old man who presented with a scrotal mass. Ultrasonography of the scrotal mass showed a nonspecific cystic mass. During surgery, the mass was revealed to be a herniated bladder.

Cystogram with dumbbell shaped urinary bladder in a sliding inguinal hernia

Sliding inguinal hernias present with various symptoms and these are usually direct inguinal hernias containing various abdominal viscera. Case reports and series have been published with various organs and rare organs being part of the hernia. Urinary bladder is a known content of sliding hernias. This case report emphasizes this aspect in a picturesque manner and the importance of radiological investigations for pre-surgical evaluation.

Robotic repair of scrotal bladder hernia during robotic prostatectomy

We report a case of scrotal bladder hernia in a 68-year-old man who was also diagnosed with prostate cancer. We fixed the herniated portion of the bladder using robotics after having successfully accomplished robotic prostatectomy. To the best of our knowledge, this is the first case report on simultaneous repair of scrotal bladder hernia and prostate cancer where both pathological findings have been treated with the assistance of robotics at a single operation.

Scrotal bladder hernia: report of two cases

Two new cases of scrotal bladder hernia (SBH) are presented. The first patient developed leakage of urine from the wound after "hydrocele" surgery. Revision of the wound showed a defect in the bladder wall. The bladder was separated from hernias sutures and closed in two layers. In the second, obese patient with a right scrotal swelling and two-stage voiding SBH was recognized preoperatively. The peritoneal sac and bladder wall were separately sutured and herniotomy was performed. The history, clinical features, pathology and treatment of SBH are summarized. The literature is briefly reviewed.

Inguinal bladder hernia masking bowel ischemia

Displacement of the bladder outside of the pelvis by way of the inguinal canal represents an infrequent presentation of an inguinal hernia that rarely causes urinary tract obstruction. However, bladder hernias can become bothersome, painful, and potentially dangerous. We report a 56-year-old man with a chronic bladder hernia who became acutely unable to empty his bladder from its position in the right hemiscrotum after a motor vehicle accident. At hernia repair, bladder and ischemic bowel were discovered, mandating significant small bowel resection. This case presents interesting considerations and potential pitfalls when evaluating a patient with a bladder hernia.

[Giant inguinoscrotal bladder hernia]

Inguinoscrotal bladder hernia occur in 0.4 to 3% of general poblation, though massive hernia are much rare. We present a new case of a giant inguinoscrotal bladder hernia, which was solved by surgery. It includes a clinical, diagnostic and therapeutic aspects, and a review of the relative literature.