Giant inguinoscrotal hernia containing intestinal segments and urinary bladder successfully repaired by simple hernioplasty technique: a case report

A Rare Case of Complete Inguinoscrotal Bladder Herniation With Ureteric Involvement: Assessing Diagnostic Challenges and Complex Surgical Management

Inguinoscrotal hernias involving the urinary bladder are exceedingly rare, constituting a small subset of inguinal hernias. We present a case of a 47-year-old male with long-standing scrotal enlargement and obstructive uropathy due to complete herniation of the bladder with ureteric involvement. Diagnostic imaging confirmed the condition. Following an open laparotomy, the bladder was reduced, and a modified Bassini technique with orchiopexy was used for repair. Recurrence of the inguinoscrotal hernia with evidence of the bladder in the scrotal sac required additional surgery. This case underscores the rarity, diagnostic complexity, and potential complications of inguinoscrotal bladder hernias. Specialized surgical techniques and a multidisciplinary approach are crucial for successful management, especially in cases of complete bladder herniation. Future considerations should include innovative approaches to enhance primary repair outcomes for extensive hernias involving the bladder.

A Case of Asymptomatic Massive Inguinoscrotal Bladder in Acute Renal Failure

Inguinal hernia is a common condition that typically affects males in the age group of 50-70 years. While often asymptomatic or mildly symptomatic, complications such as urinary bladder herniation and obstructive uropathy can occur if left untreated. We present a unique case of a 60-year-old man with a body mass index of 37 kg/m2 with a 20-year history of untreated bilateral inguinal hernias. His condition progressed to a complicated right inguinoscrotal hernia involving the bladder, leading to obstructive uropathy, acute renal failure, and pulmonary edema. Diagnostic imaging revealed hydronephrosis and obstruction of the distal right ureter, necessitating several procedures, including diuretic therapy, a nephrostogram, a nephrostomy, and ultimately hemodialysis due to persistent renal failure. Surgical management was achieved through an emergent robotic-assisted repair of the right inguinal hernia using resorbable mesh while repairing the left hernia was delayed to mitigate potential risks. This case illustrates the severe complications that can arise from a longstanding untreated inguinal hernia, highlighting the importance of routine monitoring and early intervention. It also emphasizes the diagnostic role of different imaging modalities and immediate pharmacological and surgical intervention in managing such complications. Despite the commonality of inguinal hernia, a lack of timely treatment can lead to life-threatening conditions, necessitating a comprehensive approach to management to improve patient outcomes.

Giant sliding inguinal hernia requiring intraoperative aspiration of fluid: a case report and literature review

Giant inguinal hernias are defined as inguinal hernias that extend below the midpoint of the inner thigh when the patient is in the standing position or an anteroposterior diameter of at least 30 cm or a laterolateral diameter of ~50 cm with non-reducibility for >10 years. This article presents a 39-year-old male with a five-year history of a giant left inguinal hernia that was treated with left inguinal hernia repair with mesh, orchiectomy, complicated scrotoplasty, intraoperative ultrasound and aspiration of 3.9 L of fluid from the hernia sac. Surgical repair of giant inguinal hernias can be challenging and is associated with a variety of complications. Various modalities have been described to assist in hernia reduction including debulking, or, as in this case, aspiration of the hernia sac and a preperitoneal incision. Although the Lichtenstein tension free repair is commonly used, no standard approach has been accepted.

Joint venture surgery of a giant inguinoscrotal hernia in a patient suffering from trisomy 21 and Eisenmenger's syndrome

A 44-year-old man with Trisomy 21 and Eisenmenger's syndrome underwent surgery due to a life-threatening scrotal hernia, containing the bladder, bilateral hydroceles and part of the sigmoid colon. Joint venture plastic and urologic surgery was performed with reposition of the bladder and sigmoid colon into the abdominal cavity, bilateral inguinal hernial mesh repair, left sided orchiectomy, excision of bilateral hydroceles and excision of a major part of the scrotum and recreation of the original anatomy of the penis and scrotum. This Case presents a successful outcome achieved as the patient after one-step-surgery was left to normal condition.

Repair of Inguinal Bladder Hernias Concomitant with Localized Prostate Cancer: A Case Report and Review of the Literature

This study reports two rare cases of inguinal bladder hernias accompanied by localized prostate cancers. They were treated with simultaneous repair of inguinal bladder hernias and open retropubic radical prostatectomy. Additionally, we performed a literature review on previous inguinal bladder hernias case reports. In this present study, the first patient was a 64-year-old man histopathologically diagnosed with prostate cancer; computed tomography for staging of prostate cancer revealed a “Pelvic Mickey Mouse Sign.” The second patient was a 75-year-old man with right inguinal swelling that gradually increased in size for 30 years. He was referred to our department due to nocturia and urge incontinence. His prostate-specific antigen level was 4.17 ng/mL, and a transrectal prostate biopsy revealed prostate cancer. Preoperative imaging studies revealed a right hernia wherein most of the bladder slid beyond the inguinal channel filling the scrotum. Both patients underwent the Lichtenstein technique for inguinal bladder hernias simultaneously with retropubic radical prostatectomy using separate surgical incisions to avoid urinary contamination of the mesh. In our comprehensive review of patients who underwent inguinal bladder hernias surgical repair, there were 51 cases (50 males and 1 female). The mean patient age was 60.6 ± 12.3 years. Five cases demonstrating concomitant prostate cancer were observed. This present case report is the first to describe two patients who underwent surgeries for the simultaneous repair of inguinal bladder hernias and retropubic radical prostatectomy with separate surgical incisions. Supposedly, this simultaneous approach is suitable for concomitant inguinal bladder hernias and prostate cancer treatment.

Transinguinal preperitoneal repair of giant inguinoscrotal hernias using Kugel mesh

INTRODUCTION

Giant inguinoscrotal hernias are rarely encountered in clinical settings, and their repair is technically challenging. The aim of this study is to evaluate the efficacy of transinguinal preperitoneal repair (TIPP) of giant inguinoscrotal hernias using Kugel mesh.

METHODS

A retrospective analysis was conducted on 9 patients with 11 giant inguinoscrotal hernias who underwent TIPP repair using Kugel mesh between December 2008 and January 2019. Demographics and perioperative and postoperative data were collected, and the operative experience was summarized.

RESULTS

The patients underwent a successful repair procedure with simultaneous omentectomy but without resection of the other abdominal organs. The median operation time was 120min, the median intraoperative blood loss was 75mL and the median defect area was 72 cm². The median duration for diet restoration was 4 days, and the median postoperative hospital stay was 6 days. The drainage tube placed in the preperitoneal space was removed after a median duration of 5 days, and the drainage tube placed in the distal hernia sac was removed after a median duration of 6 days. Three patients suffered from a postoperative increase in intra-abdominal pressure, while one patient deteriorated into abdominal compartment syndrome accompanied by respiratory dysfunction. No haematomas, seromas, incisional or mesh infections, recurrence or chronic pain occurred during the follow-up period.

CONCLUSIONS

TIPP repair using Kugel mesh is a feasible and effective method for giant inguinoscrotal hernias.

Inguinoscrotal hernia containing the urinary bladder successfully repaired using laparoscopic transabdominal preperitoneal repair technique: A case report

We report herein a patient with an inguinoscrotal hernia containing the urinary bladder. The hernia was safely repaired using the laparoscopic transabdominal preperitoneal repair technique. A 76-year-old man was admitted to our hospital with abdominal pain, vomiting, and diarrhea. His scrotum was swollen to fist size. Abdominal CT showed herniation of the sigmoid colon and the bladder into the right inguinal region, and his abdominal pain was attributed to incarceration of the sigmoid colon; this was manually reduced. About 1 month later, we performed transabdominal preperitoneal repair. After the direct hernial orifice was identified, the bladder was noted to be sliding from the medial side of the hernia; this was reduced. Peeling on the medial side was carried out to the middle of the abdominal wall, and the myopectineal orifice was covered with mesh. The patient was discharged on postoperative day 1.

Diagnosis and treatment of inguinal hernia of the bladder: a systematic review of the past 10 years

OBJECTIVE

Inguinoscrotal hernia (ISH) of the bladder is a rare condition involved in less than 4% of inguinal hernias. In most cases, it occurs to men older than 50 years who are overweight. Little is known about the subject and mainly based on case reports. When undiagnosed, it may be associated with bladder injuries during hernia repair. There is also no consensus on the ideal repair technique to use. The aim of the study is to evaluate the particularity of the management of the inguinal herniation of the bladder in term of diagnosis, choice and results of treatments.

METHODS

A Prisma systematic review of the literature was performed over the last 10 years using a database. We selected 51 articles including 64 patients with ISH of the bladder.

RESULTS

ISH of the bladder mainly occurred in overweight men aged over 50 years (Body Mass Index >30). Symptoms were reported for 76% of the patients (n=49), including inguinal swelling 60% of cases (n=38), lower urinary tract symptoms (48%), pain (40%) and a reduction of an inguinal mass after voiding (12.7%). Diagnosis was incidental on imaging for 7 patients, during inguinal repair surgery for 8, or on imaging performed following symptoms for the remaining 49 patients. Surgical repair was reported for 46 patients (71%) including various procedures as open surgery (80%) and laparoscopic approaches (20%). Excellent short term results were reported.

CONCLUSION

ISH of the bladder seams more likely to occur with patients suffering from lower urinary tract obstruction and best diagnosed with a computerized tomography scan. Various surgical techniques are reported.

Laparoscopic transabdominal preperitoneal approach for giant inguinal hernias

BACKGROUND

Many surgical techniques have been developed to treat inguinal hernia. In recent years, the laparoscopic transabdominal preperitoneal (TAPP) approach has been widely performed to repair inguinal hernia. Giant inguinal hernia (GIH) is an extremely rare disease that is a challenge for general surgeons. GIH appears when patients neglect the treatment for many years and it is defined as an inguinal hernia that extends below the midpoint of inner thigh in standing position. According to previous publications, the Lichtenstein tension-free hernioplasty is recommended to repair GIH. In this article, we describe consecutive four cases of GIH repaired via the TAPP approach.

METHODS

From April 2015 to March 2017, 200 patients underwent hernioplasty against inguinal hernia at our hospital. Inguinal hernias were treated via the TAPP approach in principle. We performed hernioplasty via the TAPP approach in all 4 patients (2%) who met the definition of Type 1 GIH. Demographic information, maximum diameter of hernia sac, hernia orifice size, and surgical data were obtained.

RESULTS

The mean operative time was 135 min. No intraoperative complications were encountered. All patients could walk from postoperative day 1 and were discharged home early, but they all had scrotal seromas. Three patients did not need puncture or drainage, but one of them required puncture. All seromas disappeared within 6 months. There was no recurrence in the 8- to 24-month follow-up.

CONCLUSION

The TAPP approach is a feasible, safe therapeutic option that may reduce wound size and pain following surgical treatment of Type 1 GIH.

Surgical treatment strategies for giant inguinoscrotal hernia - a case report with review of the literature

BACKGROUND

An inguinoscrotal hernia is defined as "giant" if descending below the midpoint of the inner thigh of a patient in upright position. In developed countries this is a rare entity. In the literature different surgical techniques have been reported so far to achieve a successful treatment.

CASE PRESENTATION

We present the case of a 63 year-old man suffering from a giant inguinoscrotal hernia, whom we treated using a combined open transabdominal and inguinal approach following an unsuccessful laparoscopic attempt. Meshes were placed in a premuscular position (Lichtenstein's procedure) and in a preperitoneal position. In addition, a reconstruction of the abdominal wall by modified components separation technique was performed. During the early postoperative period no complications were registered. Intensive care treatment was not necessary. The patient was discharged on postoperative day 8 in an excellent condition. Six months after surgery a scrotal hematocele was diagnosed and operatively removed. After a follow-up of 1.5 years neither hernia recurrence, nor chronic groin pain were recorded. The patient reported to be sexually active. His quality of life improved notably. Additionally, a Medline and PubMed database research was performed to create an overall picture of the existing surgical treatment strategies. Included were patients with diagnosis of primary giant inguinoscrotal hernia according to the given definition. Emergency interventions and cases without details of the surgical approach were excluded.

CONCLUSIONS

Firstly, this report describes a novel, successful surgical treatment of a giant inguinoscrotal hernia without administering preoperative progressive pneumoperitoneum therapy or visceral resection. Secondly, we summarize cases previously reported as a practical guide for possible surgical therapy approaches.

Giant Inguinal Herniae Managed by Primary Repair: A Case Series

Giant inguinal hernia are usually found in developing countries due to delay in seeking medical attention. The management of such hernias may sometimes require procedures to increase the intra-peritoneal capacity prior to the repair of the giant hernia. Otherwise patients may develop abdominal compartment syndrome leading to various unwanted complications. Primary repair of giant hernias are possible in some cases without having significant post-operative complications. In this present case series, we have managed a total of four patients of giant inguinal hernia by primary repair without much post-operative complications.

Treatment of a half century year old giant inguinoscrotal hernia. A case report

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Giant inguinoscrotal hernias are a rare entity in modern clinical practice mainly because of the patient’s neglect.

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Our patient had a type II giant inguinoscrotal hernia extending below the midline between mid-inner thigh and suprapatellar bone lines.

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We avoided preoperative or intraoperative procedures for the lengthening of the abdominal wall.

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Despite the longevity and size of the hernia, we avoided a debulking procedure, instead we performed a lower midline incision and connected it with an extended right inguinal incision.

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Patient’s recovery was uneventful with no complications or signs of recurrence at 6 month follow up.

Introduction

Inguinal hernias, although a common medical entity, can on rare occasions present as giant inguinoscrotal hernias, mostly because of the patient’s rejection of timely surgical management.

Presentation of case

A 77 year old patient, with a giant inguinoscrotal hernia history for more than 50 years, was advised to undergo surgical treatment due to recurrent urinary tract infections and vague abdominal pain. Physical examination showed a right sided giant inguinoscrotal hernia extending below the midpoint of the inner thigh. Preoperative CT examination confirmed a giant inguinoscrotal hernia containing the whole of the small bowel along with its mesentery.

Discussion

Giant inguinoscrotal hernias are classified into three types based on size, with each one posing a challenge to treat. There are a number of surgical options and recommendations available, depending on the type of hernia. They require close postoperative observation, because the sudden increase in the intra-abdominal pressure can account for a number of complications. Our case was classified as a type II hernia, having longevity of more than 50 years. Despite this, it was treated with forced reduction and no debulking through an extended inguinal and lower midline incision, forming a ‘V shaped’ incision. Patient recovery was uneventful and he was discharged on the 10th postoperative day.

Conclusion

Preoperative management and the correct surgical plan depending on the case are key elements in the successful treatment of this rare surgical entity.