Obstructive Uropathy and Sepsis Caused by an Inguinoscrotal Bladder Hernia: A Case Report.

Abstract

Inguinoscrotal bladder hernia is a very rare pathology, occurring in up to 4% of all inguinal hernias in the general population. We present a case of an inguinoscrotal bladder hernia causing obstructive uropathy and sepsis. A 59-year-old obese man presented with left-sided flank and abdominal pain that radiated to his left groin. On initial clinical examination, there was no evidence of an inguinal hernia. A computed tomography scan revealed a left inguinoscrotal bladder hernia with associated left-sided upper tract urinary obstruction. Two days later, his clinical course deteriorated and he developed sepsis of urinary origin. The patient underwent multiple procedures, including left ureteral stent placement, left percutaneous nephrostomy tube placement, and left inguinal herniorrhaphy. As of this writing, he remains with a left nephrostomy tube in place because of persistence of left hydroureteronephrosis, but he is doing well clinically. We highlight the fact that in cases where there is upper urinary tract obstruction and sepsis, it is prudent to first stabilize the patient via decompression of the upper urinary tract and antibiotics before herniorrhaphy. This report illustrates a unique case of this interesting pathology, as well as the multiple complications and pitfalls that may arise from it.