Uncommon content in groin hernia sac

Groin hernia may have very unusual sac content. Vermiform appendix, acute appendicitis, ovary, fallopian tube and urinary bladder have been rarely reported. We aimed to present our experience with these unusual hernia contents. Records of 1,950 groin hernia patients were retrospectively analyzed. Vermiform appendix was found in 0.51% and acute appendicitis was found in 0.10% of groin hernia sacs. The incidence of appendix in femoral hernia was 5%, while inguinal hernia sac contained ovary and fallopian tube in 2.9% of the cases. The incidence of groin hernias containing urinary bladder was 0.36%. We also had 1 patient with incarcerated bladder diverticula in an indirect hernia sac. Iatrogenic bladder injury occurred in 2 patients. Although rare, a groin hernia sac may contain vermiform appendix and exceptionally acute appendicitis. Tubal and ovarian herniation in inguinal hernias can be found in adult and perimenopausal women with an incidence as high as in children. Urinary bladder hernia occurs with a similar incidence of tuba-ovarian hernia, however, it requires special attention because of a high risk of iatrogenic bladder injury during the inguinal dissection. Every effort should be made to preserve the organ found in hernia sac for an uneventful postoperative period.     

A case of urinary bladder hernia]

A 77-year-old male visited our hospital complaining of swelling in the right scrotal and inguinal region, urinary urgency and difficulty of urination. Physical examination revealed an elastic soft mass in the right inguinal region toward the right scrotum. Rectal examination proved that the prostate was moderately enlarged. Cystogram and urethrography showed hernia of the bladder into the right scrotum and benign prostatic hyperplasia. Urodynamic studies demonstrated organic obstruction in the lower urinary tract. Transurethral resection of the prostate was done for benign prostatic hyperplasia. Later, surgical treatment for the bladder hernia was performed by replacing the bladder into the pelvic cavity and closing the hernial ring without resection of the bladder wall. The bladder hernia proved to be a para-peritoneal type. The postoperative course was uneventful. The previous reports of urinary bladder hernia are reviewed and the incidence, etiology, diagnosis the treatment are discussed.     

Inguinal hernia containing urinary bladder—A case report

IntroductionInguinal bladder hernia is rare condition found in about 1–5% of inguinal hernias. The condition is usually diagnosed intraoperatively. Patients rarely have symptoms regarding urinary tract. The best management is surgical, open surgical technique is preferred over laparoscopic. Possible urinary tract damage during surgery should be recognized and resolved.Case presentationThe following paper presents case of inguinal bladder hernia in 82-year old Caucasian male. Patient presented at our emergency department with incarcerated left inguinal hernia. Preoperative ultrasound has shown small bowel loop inside hernia sac. The condition was diagnosed intraoperatively – the whole bladder was found inside hernia sac. During surgery minor damage of the bladder was caused and repaired. Hernia defect was repaired using Bassini hernioplasty.DiscussionElderly male more often present with inguinal bladder hernia. Sometimes urinary malignancy may be cause for inguinal bladder hernia. In cases where inguinal bladder is found inside hernia sac, urologist should be consulted to exclude urological pathology. Surgical treatment is indicated in all symptomatic patients. Patients with small, asymptomatic inguinal bladder hernias could be treated conservatively.ConclusionPhysicians seeing patients with inguinal hernia should be aware that patient may have inguinal bladder hernia, especially in patients presenting with newly developed symptoms of lower urinary tract.     

The surgical implications of herniation of the urinary bladder

The urinary bladder is often involved in an inguinal hernia, but herniation of the entire bladder into the scrotum is rare. As many as 4% of inguinal hernias may involve the bladder, usually in the form of a sliding hernia. Most urinary bladder herniations are diagnosed at the time of inguinal herniorrhaphy, and are therefore most commonly repaired through an inguinal incision. If the diagnosis requires amendment, alternative surgical approaches are available. We studied two patients with massive inguinoscrotal herniation of the urinary bladder, commonly referred to as "scrotal cystocele." We reviewed the literature, incidence, causes, diagnosis, and surgical consideration of herniation of the urinary bladder, and gave particular attention to the interrelationship of bladder herniations with inguinal hernias.     

三例腹股沟疝患者疝囊充气造影螺旋CT检查的诊断价值

目的探讨疝囊充气造影螺旋CT检查对腹股沟疝的诊断价值。方法对2例腹股沟斜疝和1例膀胱滑疝患者,实施气腹造影螺旋CT扫描检查,分析影像特点,进行术前预判。结果2例腹股沟斜疝清晰显示出卵圆形充气疝囊以及疝囊颈的大小和长度等特征。1例膀胱滑疝见部分膀胱组织突向疝囊内,无充气疝囊显示。所有患者影像结果和手术所见完全一致。结论气腹疝囊造影螺旋CT检查不必待疝内容物充填疝囊后即可作出临床诊断,较传统的液体疝囊造影,敏感性好且干扰少,成像质量高,有助于术前疝分型的规范判别,并有望在早期疝,隐匿性疝等缺乏明确体征患者的诊断中发挥独特的作用。     

Vesical calculus formation on non-absorbable sutures used for open inguinal hernia repair

INTRODUCTION

Iatrogenic injuries to the urogenital tract are rare, with the bladder being the organ most affected. We describe a case of a vesical calculus that formed on non-absorbable sutures that were used to repair an inguinal hernia.

PRESENTATION OF CASE

A 45-year-old male presented with frank haematuria and dysuria 2 years following an open left inguinal hernia repair. A CT urography showed a vesical calculus adherent to the left anterio-lateral wall of the bladder. Cystoscopy revealed that the calculus formed on non-absorbable sutures. Cystolapaxy was performed followed by cystoscopic excision of the sutures. The patient''s post-operative course was uneventful.

DISCUSSION

Foreign bodies in the urinary bladder always act as a nidus for formation of a calculus. Iatrogenic bladder injuries are common during hernia repair. It is however rare for sutures used to repair an inguinal hernia to involve the urinary bladder wall. The patient most likely had a full bladder at the time of hernia repair or the bladder was part of the contents of the hernia sac.

CONCLUSION

This case illustrates the need to ensure that the bladder is empty prior to pelvic surgery and for surgeons to have a good understanding of inguinal anatomy to avoid injuring the contents of the hernia sac.     

Laparoscopic management of mesh migration into urinary bladder following laparoscopic totally extraperitoneal inguinal hernia repair—A case report

Introduction and importanceMesh migration into urinary bladder is one of the rare complications following inguinal hernia repair (Laparoscopic/Open). On reviewing the literature, erosion of mesh following inguinal hernia repair has been into the urinary bladder in most of the cases, and the erosion may occur as early or late complication. It may occur as a result of improper suturing, inadequate fixation or foreign body reaction. The most common presentation is recurrent urinary tract infection and haematuria and may mimic bladder malignancy.Case presentationA 38-year male presented with recurrent UTI and mimicked to have bladder malignancy on CT scan. On Cystoscopy, mesh along with tackers is visualized within the bladder lumen. A diagnosis of Mesh migration into bladder following laparoscopic inguinal hernia repair was made. The Patient underwent Complete laparoscopic removal of mesh with partial cystectomy, per urethral and suprapubic catheter were placed. The patient made a good recovery without any post-operative complications. On follow-up, Patient underwent Fluoroscopy to look for urinary leakage, and suprapubic catheter removal was done. Patient is asymptomatic on follow-up.Clinical discussionMesh migration into bladder is one the rare complications following laparoscopic hernia repair. Proper preoperative evaluation is necessary to determine whether mesh is free floating in the bladder lumen or adherent to bladder wall. This will help in deciding the surgical technique for route of extraction.ConclusionA case of mesh migration into the bladder can be easily managed by laparoscopic TAPP approach and it is better approach compared to other techniques.     

Urodynamic study in the neurogenic bladder dysfunction caused by intervertebral disk hernia

AIMS: To discuss the clinical significance of urodynamic studies in neurogenic bladder dysfunction caused by intervertebral disk hernia. METHODS: Thirty patients with neurogenic bladder dysfunction caused by intervertebral disk hernia were divided into three groups according to the category of detrusor muscle activity: neurogenic detrusor overactivity without detrusor sphincter dyssynergia (DSD), neurogenic detrusor overactivity with DSD, or detrusor underactivity. The patients were divided into three groups according to the condition of urinary retention and incontinence: urinary retention, urinary incontinence, or neither urinary retention nor urinary incontinence. Also they were divided into three groups according to the location of the intervertebral disk hernia: cervical hernia, thoracic hernia, or lumbar hernia. All patients underwent computer tomography (CT), magnetic resonance imaging (MRI), and urodynamic study. The results were analyzed statistically. RESULTS: There was significant correlation between the category of detrusor muscle activity, bladder compliance (BC, P < 0.05), and the pressure at maximum flow (P(det,Qmax), P < 0.01). There were significant differences in post void residual (PVR), cystometric capacity (CC), and maximum flow rate (Qmax) between the three groups of urinary retention, urinary incontinence, and the group of neither retention nor incontinence (P < 0.05). There was statistical correlation between the location of the intervertebral disk hernia and the urodynamic results. There was significant correlation between the BC (the threshold was 15 ml/cmH(2)O), detrusor pressure (Pdet, the threshold was 40 cmH(2)O), DSD, the location of intervertebral disk hernia, and the upper urinary tract lesion (P < 0.01). CONCLUSIONS: Urodynamic studies are indispensable in the classification, diagnosis, treatment, and prognosis of the neurogenic bladder dysfunction caused by intervertebral disk hernia.     

Clinical and radiographic findings of a sliding inguinoscrotal hernia containing the urinary bladder

Large sliding inguinal hernias involving the urinary bladder are rare. We present the relevant clinical data, radiographic images, and the intraoperative findings of a sliding inguinoscrotal herniation of the urinary bladder. A 67-year-old male presented with a scrotal mass and the need to manually compress his scrotum in order to void. Diagnosed with a large sliding inguinal hernia with significant bladder involvement (scrotal cystocele), the patient underwent an inguinal herniorraphy and replacement of the bladder in the retroperitoneal space. Surgery proved to be successful in the management of the inguinal hernia and voiding dysfunction.     

Incarcerated Vesico-Inguinal Hernia: a Case Report

In this paper we report a rare case of an incarcerated inguinoscrotal hernia of the urinary bladder in a 64-year-old male patient. He presented with a giant inguinal hernia and pollakisuria. The bladder was surgically repositioned intra-abdominally and resection of part of the bladder fundus was performed through laparotomy. Closure of the inguinal defect was performed through an inguinal approach. The patient’s further recovery was uneventful. Herniation of the bladder is a very infrequent finding in inguinal hernias. We searched the literature and only found a few case reports describing this rare pathology. The literature and treatment options are discussed.     

The involvement of the urinary tract in inguinal hernias

The involvement of the organs of the urinary tract in an inguinal hernia represent a constant trap for the surgeon because the diagnosis of that pathology is very rare. The authors report two cases: 1) male, carrier of a voluminous bilateral inguinal hernia, that on the right, contains a diverticulum of the bladder. 2) male, with a bilateral inguinoscrotal hernia. Bilaterally the hernia contains the ureter. The hernias of the bladder properly called are very rare but the involvement of a small portion of the organ, often a diverticulum, in an inguinal hernia is more frequent and always associated with hypertrophy of the prostate. The relative symptoms to this interest seem to supply obvious indications but very rarely are interpreted in the right way. The hernias of ureter are rare too, some acquired, some, about a quarter, congenital. The case-history don't supply useful news for the diagnosis. In the most of the cases of involvement of the urinary tract organs in an inguinal hernia, we arrived at operative-room without knowing the hernia content. The structures of urinary tract usually are recognised by particular maneuvers but is not infrequent that, moreover unforeseen, they are accidentally damaged.     

A case of inguinal bladder hernia]

Pyelocystography on a 61-year-old man with a ureteral stone incidentally revealed the inguinal bladder hernia. He had no complaint of urinary disturbances. During the operation for the hernia, we could not find the bladder without transurethral saline instillation; only the intestine covered with peritoneum was in sight. Utility of preoperative cystography on the cases of inguinal hernia is discussed.     

膀胱滑疝32例临床分析

目的 提高对成人膀胱滑疝的诊治水平.方法 回顾性分析1984年至2009年间32例成人膀胱滑疝患者的临床资料.32例患者患处均有不适感,存在大小不等的疝块.29例有尿频、尿急、排尿时疝块胀痛或发胀等泌尿系症状.15例有间断性分期排尿;29例疝块外观呈双峰形,当膀胱充盈时疝块增大,排尿后随即缩小;32例疝块均有波动感,叩诊呈实音.经导尿管向膀胱注入生理盐水疝块可增大,抽出则缩小;膀胱造影26例显示一哑铃形影像;B超检查29例潴尿时显示囊性肿块的液性暗区,其中2例有强回声光团,认定为脱出膀胱结石.结果 术前29例诊断膀胱滑疝,3例误诊(误诊率9.4%).32例经手术治疗治愈,其中术中误切膀胱2例;脱出膀胱并发结石2例;脱出膀胱壁极度薄弱2例,均行脱出膀胱切除亦治愈.32例随访1～5年均无复发.结论 膀胱滑疝一旦确定诊断,就应手术治疗.手术中熟悉病理解剖、仔细辨认剥离是防止误切或漏诊的关键.     

A calcified foreign body in the bladder due to : an unusual complication after laparoscopic incisional hernia repair

We report a rare complication caused by a displaced tack after laparoscopic incisional hernia repair. A 41-year-old woman treated 11 months earlier for a suprapubic incisional hernia (Pfannenstiel laparotomy) received a laparoscopic repair with a bilaminar mesh fixed with tacks. Seven months later, she presented miccional irritative symptoms and chronic lower abdominal pain. Leucocyturia and microhematuria were present, and computerized tomography showed 2 calcified nodules in the bladder wall. Cystoscopy confirmed 2 calcified foreign bodies in the bladder due the tack fixation. She underwent an intra-abdominal laparoscopic exploration, which showed the protrusion of a mesh in the urinary bladder. The tacks were removed and a partial laparoscopic cystectomy including mesh protrusion was performed. The patient was discharged from hospital 4 days later without postoperative complications. At follow-up 24 months after surgery, she remains well with no pain, urinary symptoms, or hernia recurrence.     

Sliding inguinal hernia with incarceration of urinary bladder diverticulum in a child

Although inguinal herniorrhaphy is generally safe, certain complications can occur even with an experienced pediatric surgeon. We present a case of sliding right inguinal hernia with incarceration of urinary bladder diverticulum in a 2-year-old boy. A small perforation at the anterior wall of the urinary bladder, peritonitis, and kinking of the sigmoid colon occurred after the herniorrhaphy. He received exploratory laparotomy for repairing the urinary bladder perforation hole and drainage of the ascites. An anal tube was inserted to keep the sigmoid colon patent. The patient recovered from this insult gradually with an uneventful postoperative course 10 months after the operation, until the writing of this study. Surgeons should be aware of the possibility of urinary bladder diverticulum incarceration at the inguinal canal and should perform the operation meticulously.     

Laparoscopic repair of inguinoscrotal hernia with complete herniation of the urinary bladder

Summary We describe a rare case of complete herniation of the urinary bladder into a groin hernia. The hernia was operated successfully using the laparoscopic approach.     

A case of a large inguinoscrotal bladder hernia secondary to benign prostatic obstruction

Large bladder hernias protruding into the scrotum are rare, with 23 cases having been reported previously in Japan. We report a case of a patient with a bladder hernia secondary to benign prostatic obstruction who demonstrated a unique voiding procedure. The patient manually compressed his scrotum at micturition to facilitate bladder emptying. He underwent subcapsular prostatectomy, followed by inguinal hernia repair. Postoperatively, the voiding procedure and urinary flow returned to normal. We should pay attention to symptoms of bladder hernia in the follow-up of patients with bladder outlet obstruction.     

Voiding in patients managed with or without ultrasound monitoring of bladder volume after outpatient surgery.

The goal of this study was to determine whether recovery room monitoring of bladder volume would affect patient outcome after ambulatory surgery. Incidence of urinary retention and times to void and to discharge were compared in 161 patients managed with ultrasound bladder monitoring versus 173 controls without bladder monitoring. Urinary retention was diagnosed by clinical means or by ultrasound, confirmed by bladder catheterization. Patients were required to void or were catheterized before discharge. In the control patients without underlying risk factors for retention, median time to void was 95 min, and retention occurred in 0.8%, which was not significantly different from the ultrasound group (80 min and 0%, respectively). After hernia/anal surgery or spinal/epidural anesthesia, voiding was delayed (130 and 213 min), incidence of retention was increased (17% and 13%), and there was a trend toward earlier voiding (168+/-99 vs. 138+/-68 min) with bladder monitoring. We conclude that most patients at low risk of retention void within 3 h of outpatient surgery; their outcome is unaffected by bladder monitoring. After hernia/anal surgery and spinal/ epidural anesthesia, the likelihood of urinary retention is increased, and ultrasound monitoring facilitates deciding whether such patients should be catheterized. IMPLICATIONS: Incidence of bladder catheterization and urinary retention were compared in patients managed with and without ultrasound monitoring of bladder volume after outpatient surgery. Monitoring did not alter outcome in patients at low risk of retention, but it facilitated determining when to catheterize patients at high risk of retention (hernia/anal surgery, spinal/epidural anesthesia).     

Hernia vesical inguinoescrotal gigante. caso clínico y revisión de la literatura

Bladder hernia is an uncommon condition with a frequency between 0,5 and 3%, reaching the 10% between patients older than 50 years. It´s more predominant in males aged between 50 and 70. The diagnosis usually happens in the course of surgical repair of inguinal hernias, because the bladder hernia has no specific clinical findings. Management includes the resection or reduction of the bladder hernia, with de-obstruction of the lower urinary tract, if present, and repairmen of inguinal path. We report a new case and review the literature