Inguinoscrotal Herniation Research Articles

Fournier’s gangrene in voluminous inguinoscrotal herniation: Case report and review of literature

Introduction: Fournier’s gangrene (FG) is a polymicrobial life-threatening infection that affects perineal region and may extend to genitalia and abdominal wall. Necrotizing fasciitis is a rare condition and its association with large inguinoscrotal hernia even rarer. With high mortality rate, some predisposing factors are diabetes and immunodeficiency. Case presentation: We report a case of a 48-year-old man with Fournier’s gangrene associated with voluminous inguinoscrotal herniation which evolved to hernia sac exposure after debridement. Discussion: FG pathophysiology initiates with a localized infection by a combination of gram positive, gram negative and anaerobic bacteria, and its advancing leads to local inflammatory response, thrombosis, blood flow reduction and ischemia. Diagnosis depends on clinical presentation and image evaluation. Conclusion: FG management has been standard in the literature, however its association with inguinoscrotal hernias have not been considered in guidelines. Early diagnosis and proper clinical and surgical treatment are fundamental to avoid life-threatening complications and morbidities.

Sliding ureteral inguinal hernia: An uncommon embryological trick. Case report and literature review.

IntroductionInguinoscrotal herniation of the bladder is a rare clinical entity, with a frequency between 0.5% and 4% of all inguinal hernias. When the whole bladder and ureters migrate into the scrotum, it may cause urinary disorders as hydronephrosis.Case reportA 77-year-old male patient suffering from hypertrophic obstructive cardiomyopathy, obesity and diabetic disease presented with urinary disorders and left-sided inguinoscrotal hernia. Under clinical suspicion of sigmoid colon involvement in the inguinal canal, abdominal and pelvic computed tomography (CT scan) with endovenous contrast was performed, revealing a left inguinoscrotal hernia, containing the sigmoid colon and the left pelvic ureter causing left hydronephrosis.DiscussionWithout create urinary bladder wall leakage, the content of the hernial sac was reduced into the abdominal cavity. Previous subarachnoid anesthesia a left hernioplasty was performed by means of Lichtenstein's method with self-fixating mesh (Bard Adhesix) and subsequent complete resolution of the hydronephrosis.ConclusionUreter involvement should be suspected when a clinical inguinal hernia is diagnosed concurrently with unexplained hydronephrosis, renal failure, or urinary tract infection, as in the case described. When suspected, the preoperative diagnosis, particularly with CT scan, is essential to avoid complications and to reduce risk of bladder and ureter injuries during hernia repair.

Incidental Detection of Inguinoscrotal Bladder Hernia with Associated Factors on 18F-fluorodeoxyglucose PET/CT Scans.

To evaluate the associated factors of inguinoscrotal bladder hernia (ISBH), which was detected on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans. An observational study. Department of Nuclear Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey, from August 2010 to April 2021. In this study, 60 cases were subclassified in three age-matched groups; 15 patients diagnosed with ISBH in Group Ia, 15 cases with inguinoscrotal herniation (ISH) of bowel in Group Ib, and 30 patients without ISH in Group II. In the reconstructed PET/CT images, the prostate volume (PV), abdominal subcutaneous fat (SFV), and visceral fat (VFV) volumes were measured, and body mass index (BMI) was calculated. There was a statistically significant relationship between subgroups of Group I in the measurements of BMI, PV, SFV, and VFV, which were higher in Group Ia than Group Ib. The lower SFV/VFV value in Group Ib was considered as the most important risk factor in developing ISH of the bowel. A significant statistical difference was found between Group I and II in terms of PV, VFV, and SFV/VFV parameters. This study reiterated the impact of PV and the parameters representing abdominal fat distribution on ISBH development. PET/CT scan provided valuable information regarding both the hernia contents and the associated factors in which the higher PV had a significant association for the development of ISBH as well as lower SFV/VFV that was more prominent in ISH with bowel. Key Words: Inguinoscrotal bladder hernia, 18F FDG PET/CT scan, Subcutaneous fat, Prostate volume, Visceral fat.

Massive Vesical Hernias and Its Management: Case Series and Literature Review

Background: Bladder hernias are infrequent and should be treated by the urologist, or an experienced surgeon. An inguinoscrotal hernia of the bladder should be suspected in male patients with voiding symptoms and a fluctuant mass in the scrotum that changes its volume during urination. The most common characteristics found on the series were patients with advanced age, sedentary, and overweight. Case Presentation: We present a case series of 4 patients with inguinoscrotal herniation of the bladder, the surgical management, and outcome. Conclusion: The surgical technique used was inguinal plasty with Lichtenstein technique and either laparoscopic or open surgery mesh-plug placement. None had surgical complications, and none had recurrence at their follow-up.

Haemoperitoneum secondary to testicular rupture caused by blunt trauma in a stallion

SummaryTesticular trauma is a commonly reported consequence of injury to the scrotum in humans and horses. In the majority of cases in stallions, injury is caused by a kick from a mare during mating. This case report describes a traumatically induced unilateral testicular rupture in a stallion associated with haemoperitoneum and acute, severe signs of abdominal discomfort. Initially, testicular ultrasound and clinical examinations were inconclusive and the clinical signs led to a diagnosis of an inflammatory abdominal disorder, possibly caused by inguinoscrotal herniation. The patient underwent exploratory celiotomy with unilateral orchiectomy at which time no involvement of the gastrointestinal tract was noted (aside from the presence of haemoperitoneum) and the testicular trauma was discovered. As this case demonstrates, testicular trauma should be considered as a differential diagnosis for inguinoscrotal herniation in stallions with clinical signs of discomfort even when there is no history of recent mating. Detailed clinical examination should be performed to establish a diagnosis but may not be conclusive.

Inguinoscrotal Herniation of a Bladder Diverticulum on [Tc99m]-Methylene-Diphosponate (MDP) Bone Scan Diagnosed with SPECT/CT

Inguinoscrotal hernias that contain bladder diverticulae are a rare occurrence. We report the case of a 85 yearold man with intense radioactivity overlying the left pubic tubercle on [Tc99m]-methylene-diphosponate (MDP) bone scan. SPECT/CT imaging established the diagnosis of excreted urinary radioactivity within a large herniated bladder diverticulum. SPECT/CT is a useful technique for evaluation of non-osseous uptake on [Tc99m]-MDP bone scintigraphy

Inguinoscrotal Hernia of the Ureter Combined With Renal Pelvic Carcinoma

Inguinoscrotal herniation of the ureter is a rare finding, with the potential for serious surgical complications. Here wereport an extremely rare case of inguinoscrotal hernia of the ureter combined with renal pelvic carcinoma. This 61-year-old man was diagnosed with right renal pelvic tumor, bilateral hydronephrosis with inguinoscrotal hernia ofthe right ureter, and left ureteral calculus. He was successfully treated with right nephroureterectomy, inguinoscrotal hernia repair, and left ureterolithotomy. Pathologic examinations revealed a high-grade transitional cell carcinoma.

Clinical and radiographic findings of a sliding inguinoscrotal hernia containing the urinary bladder

Large sliding inguinal hernias involving the urinary bladder are rare. We present the relevant clinical data, radiographic images, and the intraoperative findings of a sliding inguinoscrotal herniation of the urinary bladder. A 67-year-old male presented with a scrotal mass and the need to manually compress his scrotum in order to void. Diagnosed with a large sliding inguinal hernia with significant bladder involvement (scrotal cystocele), the patient underwent an inguinal herniorraphy and replacement of the bladder in the retroperitoneal space. Surgery proved to be successful in the management of the inguinal hernia and voiding dysfunction.

Complications of inguinoscrotal bladder hernias: a case series

Although the urinary bladder is involved in 1-4% of all inguinal hernias, extensive inguinoscrotal herniation of the bladder, termed scrotal cystocele, is very rare. Most small asymptomatic bladder hernias are commonly encountered and reduced successfully via the same incision during elective inguinal hernia repair. However, larger bladder herniations can be associated with bladder infarction or obstruction, which require urgent intervention to preserve renal function and reduce morbidity and mortality. We present two cases of elderly men presenting with significant scrotal cystocele complications which necessitated urgent surgical intervention. We compare and contrast the two cases and discuss the presentation, investigation, diagnosis and treatment of these pathophysiological conditions.

Massive inguinoscrotal herniation of the bladder with ureter: incidental demonstration on bone scan

Inguinoscrotal herniation of the bladder is a rare clinical entity. The condition is often diagnosed incidentally or during the course of surgical repair of inguinal hernias. In a smaller number of cases, bladder hernia can be seen during nuclear medicine studies. We report a rare case of massive inguinoscrotal bladder herniation with ureter, causing urinary stasis on bone scintigraphy.

Technical Notes and Tips: Use of a Vaginal Speculum to Assist Difficult Urethral Catheterisation

Visualisation of the male urethral meatus for catheterisation can be difficult in situations such as morbid obesity, gross penile oedema or huge inguinoscrotal herniation. A novel technique in our experience is the use of a vaginal speculum to overcome this. Two persons are ideally required for effective use – one to stabilise the device within the penis, to visualise the meatus whilst the other performs the catheterisation itself. This technique allows visualisation of the urethral meatus and hence enables catheterisation to be performed with relative ease in such patients.

Inguino-scrotal hernia of a double district ureter: case report and literature review

Ureteral hernia is uncommon and usually misdiagnosed. From an anatomic point of view, we can distinguish between two uretero-inguinal hernias: intraperitoneal and extraperitoneal. Ureter inguinal hernias are nearly always indirect. This kind of hernia can include the ureter alone or, frequently, other abdominal sliding organs within the hernia sac (bladder, bowel tracts, etc.). Kidneys and urinary tracts present normal anatomic conformation, although renal ptosis may be found. As of July 2004, 139 cases of ureteral hernia had been described in the literature. Here we report a case of inguino-scrotal herniation of double district ureter and review the current literature to analyze the main clinical characteristics of this pathology and to establish pitfalls.

Paraperitoneal indirect inguinal bladder hernia: MR demonstration

Inguinal or inguinoscrotal herniation of the bladder is not uncommon and has been estimated to comprise 1% to 3% of all inguinal hernias. The appearance of hernias on ultrasonography, intravenous pyelography, cystography, and computed tomography has been described previously but no instance of correlation with magnetic resonance (MR) imaging has been documented. Nevertheless, herniated bladders can be encountered fortuitously during abdominal MR imaging, and the radiologist should be familiar with their appearance. We present a case of unsuspected paraperitoneal indirect inguinal bladder herniation demonstrated by MR. Appearance on MR is characteristic, and this modality may be useful for differentiating the several types of inguinal hernias of the bladder because of its superior soft tissue contrast. In addition, MR imaging can be used to perform imaging in any plane and dynamic examinations during straining.

Das skrotale Harnblasendivertikel - seltene Ursache einer Inguinalhernie

Massive herniation of the bladder through the inguinal canal is a rare entity. We report on a patient with a large inguinoscrotal herniation of the urinary bladder commonly referred as "scrotal cystocele". Diagnostic means and therapeutic strategies are discussed. After laparoscopic repair of a bilateral inguinal hernia, a 60-year-old man described a persistent right groin mass that varied in size with the degree of bladder distension. Diagnostic evaluation revealed a large bladder diverticulum extending into the right scrotum. Treatment consisted of inguinal resection of the bladder diverticulum, the peritoneal sack and closure of the hernia. Inguinal herniation of a large bladder diverticulum has to be considered in the differential diagnosis of inguinal hernias, especially in patients with obstructive symptoms of the bladder outlet.

Renal failure with inguinoscrotal herniation of the bladder

Renal failure with inguinoscrotal herniation of the bladder

SCROTAL HERNIATION OF THE BLADDER SECONDARY TO PROSTATE ENLARGEMENT

The roentgenographic findings of scrotal herniation of the bladder were first described by Levine in 1951.’ The term scrotal cystocele was used to describe the rare clinical condition of massive inguinoscrotal herniation of the bladder. Involvement of the bladder in inguinal hernias is not rare. However, herniation of a large portion of the bladder is uncommon. We report a case of massive inguinoscrotal herniation of the bladder secondary to large benign prostate hypertrophy. CASE REPORT A 78-year-old man presented with severe nocturia, a weak urinary stream, excessive straining and the need to squeeze the scrotum manually to void completely. Physical examination revealed a markedly enlarged prostate gland and a right inguinal hernia. Surgical history was significant for multiple repairs of the right inguinal hernia. Computerized tomography (CT) of the pelvis demonstrated a prostate gland measuring approximately 8 X 8 X 7 cm. (fig. 1, A). Subsequent images revealed the opacified bladder within the right inguinal canal, extending into the right hemiscrotum (fig. 1, B). Delayed supine images on excretory urography (Np) showed a large right inguinoscrotal herniation of the bladder with no evidence of ureteral displacement or dilatation (fig. 2). A simple retropubic prostatectomy revealed a 211 gm. benign prostate gland. The herniated portion of the bladder was reduced and elective hernioplasty was planned. DISCUSSION Herniation of the bladder may present as part of an obturator, ventral, ischiorectal, peritoneal or sciatic hernia. When the bladder is distended, it may also herniate into any pelvic or abdominal opening within its reach.2 Herniation of the bladder may be classified according to its relationship to the peritoneum. Paraperitoneal herniation is most common and is much more likely to be indirect. The bladder remains extraperitoneal being medial and alongside of the parietal

Scrotal cystocele: US and CT findings in two cases

Massive inguinoscrotal herniation of the bladder (i.e. scrotal cystocele) is very uncommon. We describe the ultrasonography and computed tomography features of scrotal cystocele in two patients, and review the radiologic findings of this rare entity reported in the literature.

Computed tomography findings in scrotal cystocele

A vesical component is recognizable in 1-4% of groin hernias [1]. Bladder hernias can be limited to the inguinal canal or involve the scrotum [2]. Levine gave the term 'scrotal cystocele' to the large inguinoscrotal herniation of the bladder [3]. Scrotal cystocele is generally identified in male subjects over 50 years old [2]. Usually, this abnormality is evaluated with urography or cystography [2,3]. We report a case of inguinoscrotal

Scrotal cystocele diagnosed by computed tomography

Computed tomographic scans of the pelvis that demonstrate anterolateral "pointing" of the urinary bladder suggest the possibility of inguinoscrotal herniation (scrotal "cystocele"), a rare but clinically relevant condition if it is not recognized preoperatively.