Combined incarceration of bladder and ileum in inguinal hernias

Abstract

Two cases are presented in which the small bowel and bladder became incarcerated in long-standing inguinoscrotal hernias. In the first and unique case, both small bowel and bladder became gangrenous after thirty hours of incarceration. This patient had no urinary symptoms at any time either during the twenty years of the hernia's presence or during the thirty hours of incarceration. He voided normally during the period of incarceration despite the fact that the bladder was becoming gangrenous in the hernia. The only preoperative finding suggesting bladder involvement was the 70 to 80 red blood cells noted in the urine voided thirty minutes before surgery. In the second case incarceration developed one week before admission and definite urinary symptoms were present during the period of incarceration. In this case preoperative cystography allowed a precise diagnosis of incarcerated bladder hernia to be made. A review of the literature on bladder hernias is included with particular reference to incidence, anatomy, and diagnosis. It is emphasized that diagnosis of bladder hernia is rarely made preoperatively because of the absence of symptoms. This is particularly true in strangulated hernias when the symptoms of strangulation are striking and mask any vague urinary symptoms that may be present. The diagnosis of strangulated small bowel is readily made, but the diagnosis of strangulated bladder hernia will only be made if the surgeon is aware of the possibility in the absence of urinary symptoms. Ten to fifteen per cent of all bladder hernias are first recognized as postoperative complications after injury to the bladder during surgery. It is suggested that all patients with large hernias undergo cystography prior to elective or emergency surgery. This procedure is diagnostic of bladder hernia and is simple, rapid, and safe to perform.