Hernia vesical inguinoescrotal incarcerada: manejo quirúrgico / Incarcerated inguinoscrotal bladder hernia: surgical management

RESUMEN La hernia vesical es una entidad asociada a la hernia inguinal, con predisposición de lado derecho, en un porcentaje de 0,5 a 3%, hasta 10% en hombres, y a partir de la quinta a séptima década de vida1. La mayoría son pequeñas; la fisiopatología más común es la obstrucción mientras que la hiperplasia prostática es la principal etiología. La presentación clínica es poco específica, y el diagnóstico es en la mayoría de los casos transoperatorio. Se presenta el caso de un paciente de género masculino de 64 años, con antecedente patológico de enfermedad de Parkinson, hernia inguinal izquierda reducible hace 5 años. Acudió a consulta médica por manifestar dolor abdominal de moderada intensidad, más aumento de volumen en región inguinoescrotal izquierda. Al realizar el examen físico se constató una hernia inguinoescrotal izquierda no reducible. Con el diagnóstico de hernia inguinal incarcerada se realizó una exploración quirúrgica, con hallazgos de hernia inguinoescrotal de gran tamaño con contenido vesical y epiplón incarcerado con cambios de coloración. Se realizó entonces la reparación de la hernia. La evolución posoperatoria fue satisfactoria sin complicaciones.

ABSTRACT Bladder hernia is a condition associated with inguinal hernia, usually right-sided, in 0.5 to 3% of the cases and up to 10% in men between the fifth and seventh decade of life. Most hernias are small; the most common pathophysiology is obstruction while prostatic hyperplasia is the main etiology. The clinical presentation is unspecific, and the diagnosis is usually made during surgery. We report the case of a 64-year-old male patient with a history of Parkinson's disease and reducible left inguinal hernia 5 years before, who sought medical advice due to abdominal pain of moderate intensity, with increased volume in the left inguinoscrotal region.On physical examination a diagnosis of left-sided non-reducible inguinoscrotal hernia was made. With the diagnosis of incarcerated inguinal hernia the patient underwent surgical exploration which showed a large inguinoscrotal hernia containing the bladder and incarcerated omentum with color changes. The hernia was repaired, and the patient evolved with favorable outcome.

Inguinoscrotal bladder hernia with cystolithiasis

@#A hernia occurs when an organ or fatty tissue squeezes through a weak spot in surrounding muscle or connective tissue, called fascia. Hernia is classified as inguinal, incisional, femoral, umbilical, or hiatal. The bladder may herniate in 1%–3% of the cases through the inguinal canal. A herniated bladder with calculus is a more unique condition that has only 3 reported cases. Reported here is a case of a 65-year-old male with a known case of left bladder inguinal hernia. He presented with an inguinoscrotal bulge at the left groin and severe lower urinary tract symptoms, associated with a need to squeeze his scrotum to complete his voiding. A Computed Tomography scan revealed inguinoscrotal bladder hernia, left with urinary bladder calculi, and an enlarged prostate gland. The patient underwent cystoscopy, inguinal exploration left, cystolithotomy, hernioplasty left. Inguinoscrotal hernia of the bladder is a rare pathology and often goes unrecognized in during surgical hernia repair. Preoperative identification of bladder hernia is essential to prevent iatrogenic trauma and severe complications. It is mandatory for general surgeons and urologists to keep in mind this rare condition during surgical repair of inguinal hernia.

Scrotal cystocele presenting with renal failure.

Extensive bladder herniation is rare. We hereby present a case of scrotal cystocele with chronic renal failure. It was managed successfully by initial nephrostomies and then definitive corrective surgery.

FDG Uptake in PET by Bladder Hernia Simulating Inguinal Metastasis

A 70-year-old man with past history of hemicolectomy due to colon cancer underwent a follow-up abdominal/pelvic CT scan. CT revealed a right adrenal metastasis and then he underwent FDG-PET/CT study to search for other possible tumor recurrence. In PET images, other than right adrenal gland, there was an unexpected intense FDG uptake at right inguinal region and at first, it was considered to be an inguinal metastasis. However, correlation of PET images to concurrent CT data revealed it to be a bladder herniation. This case provides an example that analysis of PET images without corresponding CT images can lead to an insufficient interpretation or false positive diagnosis. Hence, radiologists should be aware of the importance of a combined analysis of PET and CT data in the interpretation of integrated PET/CT and rare but intriguing conditions, such as bladder herniation, during the evaluation of PET scans in colon cancer patients.