Incarcerated inguinoscrotal bladder hernia: A case report

Abstract

Inguinoscrotal bladder hernia is a rare clinical condition, detected in less than 4 % of inguinal hernias. Urinary retention, obesity, advanced age and male gender represent its most significant risk factors. Symptoms may include inguinal pain and swelling, as well as double micturition and volume reduction of the bulge after voiding. Such an unspecific clinical presentation requires a high index of suspicion in order to reach an early diagnosis, essential to prevent major complications. Because of its rareness, literature concerning inguinoscrotal bladder hernia is scarce and its diagnostic and therapeutic care pathways lack standardization. We seek to contribute to the still limited knowledge on the subject, presenting the case of a 75-year-old patient come to our attention complaining of pain and a sense of tension in his right inguinoscrotal region, site of a voluminous incarcerated inguinoscrotal hernia. The patient reported severe urinary retention and, once catheterized, produced abundant cloudy urine. His blood test showed mild neutrophilic leukocytosis. Computed tomography documented a right-sided inguinoscrotal hernia, containing a large bladder diverticulum, confirmed by void cystoscopy. An adequate preoperative assessment, allowed us to perform an open surgical repair with a mesh free of major surgical complications. In doubtful cases or voluminous inguinoscrotal bladder hernia, computed tomography and voiding cystoscopy permit pre-operative diagnosis and accurate operative planning. Hernia repair with a mesh through an open approach appears to be the safest and most effective option.