Case - Recurrent incarcerated inguinal bladder hernia with small bowel obstruction.

Abstract

Inguinal hernias are a common surgical complaint, with a lifetime incidence requiring repair of 27% in men and 3% in women.1 Recurrence of an inguinal hernia requiring repair depends on a number of factors, including repair type, surgeon experience, and patient factors, but has been estimated at 1–4%.2,3 The bladder is involved in 1–4% of inguinal hernias in the general population, and involvement is as high as 10% in men over age 50.4 Risk factors for urinary bladder involvement in an inguinal hernia include male gender, age over 50, and obesity.5 The mainstay of treatment for an inguinal bladder hernia is herniorrhaphy. Most small bladder hernias are discovered intraoperatively due to the lack of urinary symptoms prior to herniorrhaphy. In fact, less than 7% are diagnosed preoperatively.4 Small urinary bladder hernias are often asymptomatic, but clinical manifestations can include urinary frequency, urgency, nocturia, hematuria, and double-phase micturition.6 Extensive herniation of the bladder, commonly referred to as a scrotal cystocele, is much less frequent. These are more likely to present with urinary symptoms, and urgent intervention is usually required, as bladder infarction and/or obstruction may result.6 Inguinal bladder hernias with associated small bowel obstruction are rare and rates have not been characterized in the literature. We present a case of a recurrent inguinal hernia with bladder and small bowel incarceration, as well as associated small bowel obstruction. In addition, aside from a case involving complete herniation of the bladder,6 we present the first such images of a Foley catheter balloon being found within the herniated portion of the bladder.