Paravesical Abscess as an Unusual Late Complication of Inguinal Hernia Repair in Children

Abstract

We analyzed pitfalls in the etiology, diagnosis and treatment of pediatric patients who had a paravesical abscess (PVA) resulting from previous inguinal hernia repair. We retrospectively reviewed the records of 6 children undergoing operation for PVA related to previous inguinal hernia repair between 1994 and 2002. All patients were male and 1.5 to 8 years old. The location of PVA was the right side of the bladder in 4 patients and the left side in 2. History showed that only 2 cases were complicated by early postoperative wound infection. Four patients were hospitalized with a relapse of symptoms following antibiotic treatment for possible urinary tract infection. The interval between initial inguinal hernia repair and the diagnosis of PVA was 6 to 48 months. Five patients had from recurrent lower urinary tract symptoms, 2 had ipsilateral groin discomfort and 1 had lower abdominal discomfort. There were swelling and tenderness at palpation of the ipsilateral groin in 5 patients not present at previous examinations. Only 1 patient had fever and leukocytosis. Urinalysis showed microscopic hematuria in all patients, of whom 2 had also leukocyturia. All patients had negative urine cultures. Ultrasound and computerized tomography findings suggested features of abscess formation at the paravesical space with concomitant focal thickening of the adjacent bladder wall. At surgery when entering the abscess cavity, thick pus and granulation tissues were débrided. Transfixing silk sutures were found to be secured to the adjacent bladder wall in 2 patients and in the area of the internal ring in 4. They were removed. The adjacent bladder walls needed no additional intervention. Biopsy specimens revealed only chronic inflammatory components. Antibiotics were continued for a mean of 7 days. Weekly ultrasound was performed to evaluate bladder wall thickening, which resolved completely within 3 to 5 weeks. Followup was 5 months to 6 years and no recurrence was noted. In children presenting with lower urinary tract symptoms (early period) plus findings of soft tissue infection at the ipsilateral inguinal region (late period) after inguinal hernia repair clinicians should be aware of the possibility of PVA as a primary problem to avoid insufficient treatment because its definitive treatment is removal of the infected suture material.