US evaluation of inguinoscrotal bladder hernias: report of three cases

A Rare Case of a Non-strangulated Bladder Pantaloon Hernia

A pantaloon hernia occurs when an indirect and direct hernia develop at the same time. The urinary bladder is a rare component of pantaloon hernias. There is a lack of literature regarding an ipsilateral pantaloon with a herniated urinary bladder. Clinically, it has a vague presentation associated with abdominal pain and urinary retention symptoms. The best diagnostic modality is an abdominal CT scan. Surgery is the treatment of choice, rendering a good prognosis. Untreated bladder hernia may lead to strangulation and necrosis of the urinary bladder. We present a rare case of a right-sided pantaloon hernia with a bladder herniation in a 65-year-old man.

Inguinal bladder hernia: a case report

Inguinal hernia is a common disorder that requires urgent and adequate surgical management. Multiple organs may be associated with inguinal hernias, but bladder involvement is rarely seen. The diagnosis is frequently done during surgery. It can be evoked before surgery when the patient presents with irritative and obstructive lower urinary tract symptoms. Retrograde urethrocystography or intravenous urography confirms the diagnosis. We report a case of inguinal hernia involving the bladder at the right side with a 72-year-old man. We performed a hernia repair after reintegration of the bladder.

Feasibility of robotic-assisted minimally invasive inguinal hernia repair in patients with urologic considerations including artificial urinary sphincters and bladder herniation

Robotic surgical technology has the potential to broaden the applicability of minimally invasive approaches into more complex, technically challenging inguinal hernia repairs. A unique patient population requiring inguinal hernia repair are those patients who either have artificial urinary sphincters (AUS) or inguinal bladder herniation (IBH). Traditionally, these patients have not been considered candidates for minimally invasive inguinal hernia repairs. Through this retrospective series, we aim to contribute to the growing body of literature on robotic-assisted inguinal hernia repair (RIHR) by describing our experience with RIHR in this patient subset. We performed a retrospective chart review of RIHR cases performed from June 2017 to April 2019 by a single surgeon at our university-affiliated community hospital. Charts were reviewed for preoperative considerations, operative complications, and postoperative outcomes. A total of three patients with an AUS and six patients with IBH were included, all of whom were male. All the patients received transabdominal preperitoneal (TAPP) approaches, and all received placement of mesh. There were no intraoperative complications and no conversions to open surgery. Postoperatively, one patient with IBH had persistent surgical site pain that resolved after 3 weeks and one patient, also with IBH, had a surgical site seroma that resolved without further intervention. Mean follow-up time was 10.71 and 12.13 months for patients with AUS and IBH, respectively. No patients reported hernia recurrence during this time. This review suggests that the use of robotic assistance for laparoscopic inguinal hernia repair is safe and effective and may provide additional benefits for patients with concurrent urological considerations such as AUS and IBH.

Computed tomography urography findings of complete inguinoscrotal bladder herniation

Inguinoscrotal bladder herniation (IBH) is a rare type of inguinal hernia associated with significant urologic complications such as acute renal failure, hydronephrosis, obstructive uropathy, and sepsis. Diagnosis of this condition can be made with common imaging modalities including excretory urography, retrograde cystography, computed tomography (CT), and magnetic resonance imaging. We present the classic symptomatology and imaging findings of inguinoscrotal bladder herniation on CT urogram in two patients. Although the majority of IBH are diagnosed intraoperatively, radiologists and the surgical team should be aware of this diagnosis when working up a patient, as preoperative diagnosis is crucial to assist with surgical planning and avoid intraoperative complications.

Level of evidence: 4.

Incarcerated Bladder Diverticulum in a Femoral Hernia Presenting as Recurrent Hematuria

Groin hernias are extremely common surgical pathologies and usually contain intra-abdominal viscera surrounded by peritoneum. Femoral hernias are the least common types of hernia and are predominately found in females. In rare cases, an extraperitoneal organ may be pulled into the hernia sac to become part of the content. Urinary bladder diverticulum should be considered as a possible femoral hernia content in elderly patients presenting with recurrent symptoms of lower urinary tract infections and hematuria. A high index of suspicion followed by appropriate imaging assists in making a correct preoperative diagnosis and improves postoperative outcomes. We present an uncommon case of herniation of a urinary bladder diverticulum into a femoral hernia presenting with recurrent hematuria in an elderly female.

Large inguinal bladder hernias: can a preoperative diagnosis be made?

PURPOSE

Bladder hernias are asymptomatic in most cases and are found incidentally during exploration for inguinal hernia repair. The treatment of inguinal bladder hernia is either reduction or resection of the herniated bladder, followed by herniorrhaphy. We present a case series with preoperative diagnoses, along with their surgical outcomes.

METHODS

We retrospectively reviewed the medical records from a single institution over a 5-year period (2012-2017) of five patients with diagnosis of large bladder inguinal hernia. Demographics, clinical status, medical history, anatomical structure of the hernia, and surgical outcomes were all analyzed.

RESULTS

Patients' median age was 51 years (range 45-81 years). The median size of the hernial sac was 13 cm (range 8-20 cm). The diagnosis was made with computed tomography in three patients and with ultrasonography and cystography in two patients. Median length of hospital stay was 2 days (range 1-6 days), and median length of follow-up was 28 months (range 18-72 months). All patients continue to be alive and well, without hernia recurrence. The five cases are described separately along with their surgical managements.

CONCLUSION

The main objectives in treatment of inguinal bladder hernia are to preserve the voiding function and to avoid bladder injuries in a tension-free hernia repair. To our knowledge, this is the first series of cases in which all inguinal bladder hernias were diagnosed preoperatively.

Inguinal Bladder and Ureter Hernia Permagna: Definition of a Rare Clinical Entity and Case Report

Background

Inguinoscrotal herniation of the bladder is a rare clinical entity, with a frequency between 0.5% and 4% of all inguinal hernias. The bladder can partially or entirely herniate into the inguinal canal; when the whole bladder and ureters migrate into the scrotum, it may cause urinary disorders.

Case Presentation

A 62-year-old male patient presented with urinary disorders and right-sided inguinoscrotal hernia. Under clinical suspicion of bladder involvement in the inguinal canal, abdominal and pelvic computed tomography (CT) scan with endovenous contrast was performed, revealing a right inguinoscrotal hernia, containing the whole urinary bladder and the right pelvic ureter. Without violating the urinary bladder wall integrity, the content of the hernial sac was reduced into the abdominal cavity. Hernioplasty was performed by means of Lichtenstein's method.

Conclusions

Ureteral involvement should be suspected when a clinical inguinal hernia is diagnosed concurrently with unexplained hydronephrosis, renal failure, or urinary tract infection, as in the case described. When suspected, the preoperative diagnosis, particularly with CT scan, is essential to avoid complications and to reduce risk of bladder and ureter injuries during hernia repair.

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.

An unusual inguinoscrotal hernia with renal involvement

We present a case of a 74-year-old man who, while in intensive treatment unit for an upper gastrointestinal bleed, decompensated cardiac failure and concurrent pneumonia, was found to have a large right hydronephrotic pelvic kidney and bladder within the hernia. After discharge, he was medically optimised for 7 months before undergoing an elective open mesh repair of his hernia. During the procedure, drainage of a large hydrocoele was performed to facilitate reduction of the hernia. Postoperatively, he underwent ureteric stenting due to a persistent hydronephrosis with impairment of his renal function. He subsequently made a good recovery and was discharged home with outpatient follow-up planned.

Laparoscopic repair of massive inguinal hernia containing the urinary bladder

Inguinal herniation of the urinary bladder is an extremely rare occurrence involving less than 5% of inguinal hernias reported in literature. These hernias require a high index of suspicion for their diagnosis and pose significant challenges to the operating surgeon. The majority of these hernias have been repaired by an open technique. We report two cases managed laparoscopically.

Urinary bladder diverticulum as a content of femoral hernia: a case report and review of literature

BACKGROUND

Long standing increase of the intravesical pressure resulting from urinary bladder outlet obstruction can cause both secondary bladder diverticula and groin hernias. In rare cases, a diverticulum can be pulled by a hernia sac and becomes a component of the hernia itself. Such cases were encountered in inguinal, perineal and obturator hernias. However, to our knowledge, there has been only one case reported in the literature of a bladder diverticulum herniated in to the femoral canal.

METHODS

Literature search using PubMed was performed to identify all published cases of herniation of bladder diverticula in to the femoral canal.

RESULTS

Literature search revealed only one case before the present one.

CONCLUSION

Urinary bladder diverticula should be considered as a possible content of femoral hernias especially in males with long standing obstructive lower urinary tract symptoms. As the clinical features of such a case are not specific, a high index of suspicion along with proper imaging studies are of great help in making a timely diagnosis to improve the outcome.

Beware: the inguinoscrotal hernia with urological origins

Cases of herniated bladder diverticulae causing inguinoscrotal hernias are rare, and there are 19 described in the English literature. We describe the case of a 64-year-old Caucasian man with a huge bladder diverticulum that herniated into his scrotum. The original diagnosis was that of inguinoscrotal hernia containing bowel contents. Radiological investigations revealed a urological cause, and he underwent a successful diverticulectomy. It is important to recognize that inguinoscrotal hernias can have urological origins, 1–4% being the reported figure. Clinical examination can lead to a general surgical diagnosis before further radiological investigations confirm the nature of the hernia. They prove difficult to both diagnose and surgically correct.

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.

Micturation related swelling of the scrotum

Unlike small inguinal and femoral bladder hernias, massive bladder hernias into the scrotum, also named scrotal cystoceles, are rare. We describe and discuss the clinical appearance and management of a patient with a micturation related unilateral swelling of the scrotum.

[Bilateral ureterohydronephrosis secondary to massive vesical hernia]

Bladder hernia is not a rare pathological condition, with a frequency between 0,3 and 3%. Massive bladder hernia is less frequent an very rarely ureterohydronephrosis with this pathology. We will present a case a renal failure secondary to inguinoscrotal bladder hernia with bilateral obstructive uropathy and an analyzed the clinical presentation, the diagnosis and the treatment for those hernias.

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.

Massive inguinoscrotal herniation of the bladder with ureter: incidental demonstration on bone scan

Inguinoscrotal herniation of the bladder is a rare clinical entity. The condition is often diagnosed incidentally or during the course of surgical repair of inguinal hernias. In a smaller number of cases, bladder hernia can be seen during nuclear medicine studies. We report a rare case of massive inguinoscrotal bladder herniation with ureter, causing urinary stasis on bone scintigraphy.

Inguinal herniation of a bladder diverticulum

The inguinal herniation of a bladder diverticulum is a rare entity. We report two cases and describe the findings observed by computed tomography, which allowed demonstration of the site and contents of the hernia.

Urological findings in inguinal hernias: a case report and review of the literature

We report on a rare case of massive incarcerated inguinoscrotal bladder herniation in a direct hernia and present the review of the literature on urological findings in relation to the inguinal hernial sac. The English-based literature was searched using the words inguinal hernia, bladder, ureter, diverticule, and incarceration and discussed in relation to the present case. We found 190 cases of inguinal hernia associated with urological findings, such as herniation of the bladder, ureter, and diverticulum. We also found that 11.2% of these hernias were associated with urological malignancies and 23.5% of these were associated with a variety of complications. The high-risk patients, who are males, obese, older than 50 years and who have symptoms that indicate urological pathologies to a physician, are more likely to be in the high-risk group for bladder herniation.

[Bilateral obstructive uropathy secondary to inguinoscrotal bladder hernia]

Bladder hernia is present in an important number of cases of inguinal hernias. Massive inguinoscrotal bladder hernias are rarer. The association of massive bladder hernia and bilateral ureterohydronephrosis is not often found. According to our knowledge, there have been only seven cases documented in the last ten years. Therefore, we will present a case of renal failure secondary to inguinoscrotal bladder hernia with bilateral obstructive uropathy. Once we have analyzed a clinical case, we will give the diagnosis and treatment for those hernias.

Abdominal wall hernias: cross-sectional imaging signs of incarceration determined with sonography

OBJECTIVE

The aim of this study was to determine with sonography whether distinct cross-sectional imaging signs exist that may differentiate between incarcerated and nonincarcerated abdominal wall hernias.

SUBJECTS AND METHODS

The sonographic appearance of 149 consecutive abdominal wall hernias was prospectively investigated and correlated with subsequent surgical results. Commercially available 4- to 10-MHz linear transducers and 2- to 5-MHz curved transducers were used to evaluate the hernias.

RESULTS

Surgery revealed 126 nonincarcerated and 23 incarcerated hernias. The sonographic signs suggestive of incarceration that we identified included free fluid in the hernia sac, which was observed in 91% of the incarcerated hernias and in 3% of the nonincarcerated hernias; bowel wall thickening in the hernia, which was detected in 88% of the incarcerated hernias and in none of the nonincarcerated hernias; fluid in the herniated bowel loop, which was detected in 82% of the incarcerated hernias and in 3% of the nonincarcerated hernias; and dilated bowel loops in the abdomen, which occurred in 65% of the incarcerated hernias and in none of the nonincarcerated hernias. These imaging findings allowed the identification of incarceration in all 23 cases and led to a false-positive result in two of 126 nonincarcerated hernias.

CONCLUSION

Cross-sectional imaging signs indicating hernial incarceration included free fluid in the hernial sac, bowel wall thickening in the hernia, fluid in the herniated bowel loop, and dilated bowel loops in the abdomen. Sonography is an appropriate cross-sectional imaging modality for detecting these signs that are helpful in diagnosing patients with atypical clinical presentations.

[Ultrasonographic diagnosis of massive bladder hernia at the inguinoscrotal level: report of a case]

We present a case of massive inguinoscrotal bladder hernia in a 58 years-old man with a left inguinal hernia. It was diagnosed by ultrasound during evaluation of a mass in the left inguinal region extending to the scrotum. Cystography later confirmed the ultrasound findings but provided no new information. Although filling cystography is considered to be the gold-standard radiological diagnostic procedure for this entity I the use of ultrasound should not be discarded. Firstly I because direct and indirect ultrasonographics signs characterising inguinal bladder hernias have been reported, and secondly I to help in the differential diagnosis of a scrotal mass.