A 70-year-old man was incidentally found to have significant kidney injury (creatinine 3.2 mg/dL, eGFR 19 mL/min/1.73 m2) and an enlarged erythematous tender scrotum. Computerized tomography of the abdomen and pelvis revealed a large right indirect inguinal hernia containing the bladder, bilateral distal ureters, and prostate with evidence of bladder outlet obstruction, distal ureter compression, and severe bilateral hydroureteronephrosis (Figs. 1 and 2). The patient underwent catheterisation, bilateral nephrostomy tube placements, and antegrade ureteric stent placement whilst awaiting and then proceeding to a successful open mesh inguinal hernia repair. The nephrostomies were removed on the ward and ureteric stents were removed as an out-patient once renal function had stabilised (creatinine 2.49 mg/dL, eGFR 25 mL/min/1.73 m2).
Figure 1.
CT sagittal image illustrating herniation of the urinary bladder, with the prostate gland contained at the level of the hernia neck.
Figure 2.
CT coronal image demonstrating herniation of the urinary bladder, with associated bilateral severe hydroureteronephrosis.
The bladder is reported to be involved in 1–4% of all inguinal hernias1 but complete bladder and ureter herniation remains a rare occurrence that can lead to renal failure.2 Most cases are asymptomatic and are diagnosed at the time of hernia repair;2 however, massive inguinal scrotal hernias may present with scrotal swelling, difficulty in urination, and the requirement to manually compress the hernia to complete micturition.1 Surgery is the mainstay of treatment but cases can be challenging due to lack of a standardised approach to surgical management.3
Acknowledgements
We would like to acknowledge Julia McColl in her efforts and diligence in caring for this patient.
Footnotes
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References
- 1.Bisharat M, O’Donnell M, Thompson T, MacKenzie N, Kirkpatrick D, Spence R, et al. Complications of inguinoscrotal bladder hernias: a case series. Hernia. 2008;13(1):81–84. doi: 10.1007/s10029-008-0389-6. [DOI] [PubMed] [Google Scholar]
- 2.Allameh F, Faraji S, Garousi M, Hojiati S. Inguinoscrotal herniation of bladder and ureter: A case report. Urology Case Reports. 2021;39:101821. doi: 10.1016/j.eucr.2021.101821. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Aras B, Zeren S, Ucar B, Sanal B, Bayhan Z, Korkmaz M, et al. Massive inguinoscrotal bladder hernia causing hydronephrosis: Two cases. International Journal of Surgery Case Reports. 2015;12:146–150. doi: 10.1016/j.ijscr.2015.05.014. [DOI] [PMC free article] [PubMed] [Google Scholar]