Hospital: Hospital General de Segovia.
Ciudad:
Nº:
Aut@r o Autores: J. Gutiérrez Vázquez, L.I. Pérez Sánchez, V. Fernández Cisneros, J. Gómez Herrera, B.R. Arenas García, F.J. Rodríguez Recio.,
Presentación:
A 88-year-old man with a history of right inguinal swelling that was gradually increasing in size came to the emergency department with a progressively enlarging swelling over his right inguinal region. He had hematuria and occasional urinary incontinence. On examination, he had a huge right-sided irreducible inguinal hernia. With the suspicion of complicated groin hernia an abdominopelvic CT-scan with intravenous contrast was performed, demonstrating a complete bladder herniation into the right scrotum, with hydronephrosis, herniation of the perinephric fat and bladder necrosis and strangulation as complications. The diagnosis was confirmed by surgery.
Discusión:
Herniation of the urinary bladder is an uncommon condition (1-3% of inguinal hernias). These hernias have a predilection for the right side and occurs when the urinary bladder or ureter herniates into the inguinal canal, scrotal sac or femoral canal. Bladder herniation into the scrotum has also been called scrotal cystocele. Most are asymptomatic and are discovered incidentally during radiological evaluation of inguinal hernias. However, symptoms such as dysuria, increased urinary frequency, urinary urgency, nocturia and hematuria are also common. A typical symptom will be a reduction of hernia size after passing urine, and the ability to pass urine after pressing the hernia sac. General imaging differential considerations include: bladder ears (in young infants), normal protrusion of the lateral aspect of the bladder into the inguinal canal, cystocele (usually triangular and along the midline, whereas bladder hernias are projected laterally), urinary bladder diverticulum and ureteral or intestinal hernia.
Conclusión:
Herniation of the urinary bladder is an uncommon condition (1-3% of inguinal hernias). These hernias have a predilection for the right side and occurs when the urinary bladder or ureter herniates into the inguinal canal, scrotal sac or femoral canal. Bladder herniation into the scrotum has also been called scrotal cystocele. Most are asymptomatic and are discovered incidentally during radiological evaluation of inguinal hernias. However, symptoms such as dysuria, increased urinary frequency, urinary urgency, nocturia and hematuria are also common. A typical symptom will be a reduction of hernia size after passing urine, and the ability to pass urine after pressing the hernia sac. General imaging differential considerations include: bladder ears (in young infants), normal protrusion of the lateral aspect of the bladder into the inguinal canal, cystocele (usually triangular and along the midline, whereas bladder hernias are projected laterally), urinary bladder diverticulum and ureteral or intestinal hernia.
Bibliografía:
-Wang P, Huang Y, Ye J, Gao G, Zhang F, Wu H. Large sliding inguinoscrotal hernia of the urinary bladder: A case report and literature review. Medicine (Baltimore). 2018 Mar,97(13): e9998. – Urinary bladder hernia. Radiology Reference Article. Radiopaedi