Inguinal Bladder Hernia: Case Report

doi:10.4236/oju.2013.35040

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Open Journal of Urology, 2013, 3, 217-218

http://dx.doi.org/10.4236/oju.2013.35040 Published Online September 2013 (http://www.scirp.org/journal/oju)

Inguinal Bladder Hernia: Case Report*

Guo Liang Yong1, Mun Yee Siaw2, Amelia Jia Ling Yeoh3, George Eng Geap Lee2#

1University of Aberdeen, Aberdeen, UK

2Monash University Sunway Campus, Bandar Sunway, Malaysia

3University of Adelaide, Adelaide, Australia

Email: #[email protected]

Received June 17, 2013; revised July 16, 2013; accepted July 24, 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Sliding inguinal scrotal herniatio n of the bladder is rare but well-documented in the medical literatu re. The majority of

the patients are asymptomatic and the hernia is usually diagnosed incidentally. Most authors had advocated surgically

repair of the hernia with the reduction or resection of the bladder as the definitive management. We present an unusual

case of inguinal scrotal herniation of the bladder presented as acute abdominal pain and treated with conservatively with

urethral catheterization.

Keywords: Inguinal Bladder Hernia; Conservative Management

1. Introduction

Inguinal hernia is one of the most common surgical pre-

sentations, and approximately 20 million surgical repairs

are performed annually worldwide [1]. Involvement of

the urinary bladder as a sliding inguinal scrotal hernia is

rare. The majority of patients with such condition are

asymptomatic and the urinary bladder herniation is usu-

ally diagnosed intra-operatively [2]. The surgical reduc-

tion or resection of the bladder is usually carried out

during the hernia repair as the defin itive treatment for the

sliding hernia. We present a rare case of a sliding ingui-

nal bladder hernia presented as acute abdominal pain

mimicking renal colic. After the Computed Tomography

Urogram (CTU) demonstrating the sliding urinary blad-

der inguinal herniation, the patient was successfully

treated with conservative management of catheterization.

2. Case Report

A previously well 79-year-old man presented to the Ac-

cident and Emergency Department with sudden onset of

right iliac fossa pain consistent with renal colic. The pa-

tient also complained of voiding and storage lower uri-

nary tract symptoms three days prior to the admission.

Examination revealed a palpable urinary bladder and a

non-tender mass arising from the right inguinal region

extending into the scrotu m, consisten t with non-reducible

ilio-inguinal hernia. The patient was able to urinate and

the urine microscopy demonstrated microscopic heama-

turia. In view of the symptoms of renal colic, a CTU was

conducted which demonstrated a right inguinal hernia

with the sliding contents of the right-sided wall of the

urinary bladder and omental fat (Figure 1). The bladder

demonstrated post void residual and no bowel loops were

visible in the hernia.

The patient was treated with urinary bladder catheteri-

zation which drained 300 mL of clear urine. Upon cathe-

terization, the ilio-inguinal hernia reduced and the patient

experienced instant pain relieved. After 24 hours of oral

Tamsulosin (400 mcg OD), the patient had a successful

trial of void and became symptom-free. One year fol-

lowing the initial presentation, he attended the follow-up

with no furth er recurrence of the hernia

3. Discussion

Herniation of the urinary bladder accounts for 1% to 3%

of all inguinal hernias [3]. It is frequently unilateral, on

the right side with a 70% male predominance [4]. Other

risk factors include older age, obesity and history of her-

niorrhaphy [5]. Two main factors in development of

bladder hernia are the presence of lower urinary tract

obstruction which leads to bladder distension together

with weakening of both the abdominal and the bladder

wall which enables it to slide thro ugh the dilated inguin al

ring, especially with constant increase in the pelvic

*Competing Interests: The authors declare that they have no competing

interest.

#Corresponding author.

G. L. YONG ET AL.

218

Figure 1. Right inguinal hernia, right-sided wall of the uri-

nary bladder and omental fat.

pressure during straining.

Urinary bladder hernias are often asymptomatic and

diagnosed incidentally during surgical intervention intra-

operatively [6]. The acute presentation of such sliding

hernia is rare, especially mimicking the symptoms of re-

nal colic.

Radiologic investigation such as CTU is a common

investigative modalit y for urolithiasis. Such inve stigation

has the added advantage of identifying other or concomi-

tant pathology that may cause abdominal pain. The di-

agnostic features for sliding inguinal scrotal hernia in-

volving urinary bladder are distinctive and clear cut on

CTU even without the utilization of intra-venous con-

trast.

The treatment of sliding urinary bladder inguinal-

scrotal hernia depends on the size of the hernia and the

extent of the bladder involvement. Most authors in the

literature had advocated surg ical repair of inguinal h ernia

with bladder wall resection, especially with strangulation

or necrosis of the bladder wall [7,8]. In our experience,

the simple urinary bladder catheterization has the effect

of de-compressing the bladder distension which may re-

sult in the reduction of the sliding hernia. The maneuver

also has the effect of relieving concomitant urinary reten-

tion and pain relief. The efficacy also seems to be sus-

tained one year following the treatment. In our best

knowledge, this is the first case report of a sliding ingui-

nal scrotal hernia involving urinary bladder presented

with acute abdominal pain that resolved with cathe teriza-

tion.

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