P-040 MERY'S SIGN IN LARGE INGUINO-VESICAL HERNIAS – A CASE REPORT AND REVIEW

Abstract

Abstract Inguinal bladder hernia (IBH) is a variety of inguinal hernia rarely found: the urinary bladder is involved in no more than 5% of all groin hernias. Usually asymptomatic and occuring in men aged over 50 years, it can be incidentally encountered during hernia repair. Herein we report a case of a 68 years-old obese patient with a large symptomatic IBH, containing almost whole urinary bladder and successfully treated via open hernia repair using a properitoneal mesh technique, as described by Celdran. This entity of hernia should be suspected when inguinoscrotal hernia is associated with urinary symptoms. We evoke this specific clinical sign: Mery's sign, that implies two-stage micturition, i.e. initial manual compression of hernia is followed by bladder voiding. We emphasize the importance of preoperative diagnosis in order to reduce inadvertent lesions of the bladder or ureters during hernia surgery. Diagnosis is based on ultrasound, CT, cystography, but we also stress the idea of preoperative cystoscopy. Also, uretheral catheterization is an important aspect in diagnosis – intraoperative bladder filling/insufflation with saline fluid/methylene blue. Also it is important to emphasize that postoperative diagnosis can be exerted on bladder injury and leakage occuring after surgery in at least 10%, as literature reports. Treatment of IBH is based on reducing the bladder to its native position and hernia cure: open, laparoscopic or robotic approach.