Figure 1
Ultrasound of left inguinal mass
Ultrasound image of the swelling showed a cystic fluid-containing lesion in continuity with the distended urinary bladder.
Unusual inguinal mass
SectionUroradiology & genital male imaging
Case TypeClinical Cases
AuthorsOmor Y, Chibli R,Tilfine C, Nassar I, Ajana A, Moatassim Billah N
Connected authors
50 years, male
Clinical History
A 50-year-old man presented to the emergency department with a 6-days history of left inguinal pain, and urinary symptom such as dysuria and urinary frequency.
Imaging Findings
Ultrasound image of the swelling showed a cystic fluid-containing lesion with a prominent "beak" in continuity with the distended urinary bladder (we used the high-resolution sensor to better visualize the existence of a connection with the bladder).
Computed tomography revealed a left inguinal hernia at the scrotal inguinal canal with isolated bladder involvement.
Computed tomography revealed a left inguinal hernia at the scrotal inguinal canal with isolated bladder involvement.
Discussion
Herniation of the urinary bladder accounts for 1% to 3% of all inguinal hernias. It is frequently unilateral, on the right side with a 70% male predominance. [1]
Bladder herniation is usually asymptomatic. The most frequent finding is a two-phase micturition. Other clinical findings include scrotal mass, difficulty in micturition, and fluctuation in the herniated mass during micturition. [2]
Radiographic imaging is not routinely performed in the workup of inguinal hernias, but cystography is the gold standard in diagnosis with the highest diagnostic value showing indentation of the bladder wall. [1] High-resolution ultrasound with 5-, 7.5-, or 10-MHz transducers allows better anatomic depiction and higher sensitivity for detection of scrotal abnormalities. [1] Computed tomography (CT) could be an important aid and could provide detailed information for the surgical planning. Current multidetector CT allows for a very accurate and rapid evaluation of bladder (and ureter) herniation, even on unenhanced scan. [1]
Complications of IBH include vesico-ureteric reflux, bladder rupture, hydronephrosis and strangulation, which may result in ischaemia and bladder infarction. [1]
The treatment of sliding urinary bladder inguinal scrotal hernia depends on the size of the hernia and the extent of the bladder involvement. Most authors in the literature advocate surgical repair of inguinal hernia with bladder wall resection, especially with strangulation or necrosis of the bladder wall. [1, 3]
Bladder herniation should be considered in the differential diagnosis of any inguinal, scrotal, or low abdominal wall hernia.
Bladder herniation is usually asymptomatic. The most frequent finding is a two-phase micturition. Other clinical findings include scrotal mass, difficulty in micturition, and fluctuation in the herniated mass during micturition. [2]
Radiographic imaging is not routinely performed in the workup of inguinal hernias, but cystography is the gold standard in diagnosis with the highest diagnostic value showing indentation of the bladder wall. [1] High-resolution ultrasound with 5-, 7.5-, or 10-MHz transducers allows better anatomic depiction and higher sensitivity for detection of scrotal abnormalities. [1] Computed tomography (CT) could be an important aid and could provide detailed information for the surgical planning. Current multidetector CT allows for a very accurate and rapid evaluation of bladder (and ureter) herniation, even on unenhanced scan. [1]
Complications of IBH include vesico-ureteric reflux, bladder rupture, hydronephrosis and strangulation, which may result in ischaemia and bladder infarction. [1]
The treatment of sliding urinary bladder inguinal scrotal hernia depends on the size of the hernia and the extent of the bladder involvement. Most authors in the literature advocate surgical repair of inguinal hernia with bladder wall resection, especially with strangulation or necrosis of the bladder wall. [1, 3]
Bladder herniation should be considered in the differential diagnosis of any inguinal, scrotal, or low abdominal wall hernia.
Differential Diagnosis List
Inguinal bladder hernia
Low abdominal hernia
Scrotal hernia
Final Diagnosis
Inguinal bladder hernia
References
[1] Moufid K, Touiti D, Mohamed L (2013) Inguinal bladder hernia: four case analyses. Rev Urol 15(1):32-6. (PMID: 23671403)
[2] 2. Ciancio G, Burke GW, Nery J, Huson H, Coker D, Miller J (1995) Positional obstructive uropathy secondary to ureteroneocystostomy herniation in a renal transplant recipient. J Urol 154:1471–2. (PMID: 7658562)
[3] Bueno Bravo C, García Navas R, Córdoba Martínez LA, Burgos Revilla FJ. (2011) Bladder hernia. Arch Esp Urol 64(5):465-7 (PMID: 21705819)
Case information
| URL: | https://www.eurorad.org/case/12602 |
| DOI: | 10.1594/EURORAD/CASE.12602 |
| ISSN: | 1563-4086 |
Figure 2
Axial computed tomography images of the pelvis
Image of pelvis demonstrating herniation of the bladder into the left inguinal canal.
Ultrasound of left inguinal mass
Ultrasound image of the swelling showed a cystic fluid-containing lesion in continuity with the distended urinary bladder.
Omor Y, department of Radiology, CHU avicenne, Rabat, Moroco
Omor Y, department of Radiology, CHU avicenne, Rabat, Moroco
Axial computed tomography images of the pelvis
Image of pelvis demonstrating herniation of the bladder into the left inguinal canal.
Omor Y, department of Radiology, CHU Avicenne, Rabat, Morocco
Omor Y, department of Radiology, CHU Avicenne, Rabat, Morocco