Inguinal bladder hernia: A case report and literature review

Abstract

Introduction: Cases of inguinal bladder hernia are rare, with bladder involvement seen in 1-4% of inguinal hernias. The majority of cases are diagnosed intraoperatively, with only 7% of bladder hernias identified prior to surgery. Diagnosis may be challenging as patients are often asymptomatic or have nonspecific symptoms. Surgical repair is currently the standard treatment, and careful surgical planning is necessary to avoid complications including bladder injury.

Presentation of case: A 58-year-old man presented to our Emergency Department with 2-day history of progressively worsening left lower quadrant pain, groin bulge, and dysuria. Physical exam revealed an irreducible left inguinal hernia associated with urinary urgency on attempted reduction. Plain CT was ordered and demonstrated inguinal hernia with bladder protrusion into the left scrotum. The patient underwent open surgical reduction and hernia repair and made a quick postoperative recovery without complications.

Discussion: Inguinal bladder hernia most often presents in older, obese males and clinicians should have a high index of suspicion when assessing patients with inguinal hernia. Preoperative diagnosis based on history, physical, and radiologic imaging allow for careful surgical planning and prevention of severe complications including bladder injury and leakage.

Conclusion: We present a case report of inguinal bladder hernia in a middle-aged man that presented as left lower quadrant pain, groin pain, and dysuria. Diagnosis was confirmed preoperatively with radiographic imaging. The hernia was surgically reduced and the defect repaired without complications.

Keywords: Bladder hernia; Inguinal hernia; Urinary bladder; Urinary leakage.

Fig. 1

A. CT scan showing bladder herniated/protruded into the Left groin; axial view. B. CT scan of the pelvis shows a slice through the bladder intraperitoneally and a part of the bladder herniating through the Left inguinal hernia/groin. The urinary bladder is stretched into the left inguinal hernia. No bladder mass or calcifications seen/present.

Fig. 2

A. Left inguinal incision seen (patient’s head is to the right of the photo, the patient’s feet to the left of the photo); bladder starting to distend as the bladder catheter was being filled with sterile saline. Penrose drain seen around the inguinal cord structures. B. Distended bladder seen via the left inguinal incisions (head of the pt is to the right of the picture; feet of the pt to the left of the picture). The bladder is protruding through the inguinal/groin incision filled with sterile saline via the bladder catheter.