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Inguinal bladder herniation

Images

Figure 1

Figure 2

Figure 3


Clinical History:

64-year-old male had an abdomen CT for possible metastasis of lung

tumor. There were no urinary symptoms.


Findings:

Figure 1: Axial image at the level of the bladder and the perineum shows right

lower part of the bladder extending into the right inguinal canal (arrow).

Figure 2-3: Coronal and sagittal images of large inguinal hernia. Bladder is the only

content of the hernia sac on the coronal image. The neck of the hernia sac is clearly

identified on sagittal image (arrow).


Diagnosis:

Inguinal hernia containing bladder


Discussion:

Herniation of the urinary bladder into the inguinal canal is a rare entity. It is reported to be present in 1–3% of all inguinal hernias (1). There is no finding that it is congenital, so it is accepted to be an acquired pathology (2). Bladder herniation is usually asymptomatic. Cinical findings include scrotal mass, difficulty in micturition, and fluctuation in the herniated mass during micturition (3).It is usually diagnosed incidentally or due to the symptoms of the urinary system (3). The preoperative diagnosis of bladder herniations is important to prevent the possible iatrogenic trauma that can occur during surgery. As it is true with our case, computed tomography (CT) outlines all the details of herniation. Although both cystography and CT will show bladder herniation, CT gives additional information on associated bowel involvement and hydronephrosis in a single study.


References / Suggested Reading:

1. Miscellaneous disorders. In: Witten DM, Myers GH, Utz DC, editors. Clinical urography: an atlas and textbook of roentgenologic diagnosis. 4th ed. Philadelphia: WB Saunders, 1977. pp. 2205– 47.
2. Laniewski PJ, Watters GR, Tomlinson P. Herniation of the bladder trigone into an inguinal hernia causing acute urinary obstruction and acute renal failure. J Urol 1996;156:1438– 9.
3. Ciancio G, Burke GW, Nery J, Huson H, Coker D, Miller J. Positional obstructive uropathy secondary to ureteroneocystostomy herniation in a renal transplant recipient. J Urol 1995;154:1471 –2.


Author

Mehmet Ruhi Onur

Assistant Professor

University of Firat Faculty of Medicine Department of Radiology

jdogra's picture
Offline
Joined: 05/23/2007
Excellent case

Ruhi:
Thank you for your Submission.

Dr. Vikram Singh Dogra

Professor of Radiology, Urology & BME
Associate Chair for Education and Research.
Department of Imaging Sciences
University of Rochester School of Medicine