I saw the “hourglass” sign: CT diagnosis of inguinoscrotal bladder herniation with pseudo-diverticula

Abstract

Bladder herniation into the inguinoscrotal region is an uncommon condition that can present with lower urinary tract symptoms and scrotal swelling. Early recognition is critical to avoid serious complications during surgical repair. We report a case of a 75-year-old man with a history of multiple left inguinal hernia repairs who presented with urinary urgency, urge incontinence, and hematuria. Physical examination revealed a persistent scrotal mass. Contrast-enhanced computed tomography (CT) showed a cystic lesion within the left scrotum, directly communicating with the urinary bladder. Delayed-phase images demonstrated progressive opacification of the herniated bladder segment, resembling an “hourglass” configuration. Pseudo-diverticula were also observed within the herniated portion, suggesting chronic bladder outlet obstruction. Given symptom improvement and surgical history, the patient opted for conservative management. This case highlights the importance of recognizing the “Hourglass” sign on CT imaging as a diagnostic clue for inguinoscrotal bladder hernias, aiding early diagnosis and preventing intraoperative complications.