Urinary bladder diverticulum as a content of femoral hernia: a case report and review of literature

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Abstract

Background

Long standing increase of the intravesical pressure resulting from urinary bladder outlet obstruction can cause both secondary bladder diverticula and groin hernias. In rare cases, a diverticulum can be pulled by a hernia sac and becomes a component of the hernia itself. Such cases were encountered in inguinal, perineal and obturator hernias. However, to our knowledge, there has been only one case reported in the literature of a bladder diverticulum herniated in to the femoral canal.

Methods

Literature search using PubMed was performed to identify all published cases of herniation of bladder diverticula in to the femoral canal.

Results

Literature search revealed only one case before the present one.

Conclusion

Urinary bladder diverticula should be considered as a possible content of femoral hernias especially in males with long standing obstructive lower urinary tract symptoms. As the clinical features of such a case are not specific, a high index of suspicion along with proper imaging studies are of great help in making a timely diagnosis to improve the outcome.

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Most cited references 12

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Emergency femoral hernia repair: a study based on a national register.

Gabriel Sandblom, Ulf Gunnarsson, S Wollert … (2009)

To describe the characteristics of femoral hernias and outcome of femoral repairs, with special emphasis on emergency operations. Femoral hernias account for 2% to 4% of all groin hernias. However, the lack of large-scale studies has made it impossible to draw conclusions regarding the best management of these hernias. The study is based on patients 15 years or older who underwent groin hernia repair 1992 to 2006 at units participating in the Swedish Hernia Register. Three thousand nine hundred eighty femoral hernia repairs were registered, 1490 on men and 2490 on women: 1430 (35.9%) patients underwent emergency surgery compared with 4.9% of the 138,309 patients with inguinal hernias. Bowel resection was performed in 22.7% (325) of emergent femoral repairs and 5.4% (363) of emergent inguinal repairs. Women had a substantial over risk for undergoing emergency femoral surgery compared with men (40.6% vs. 28.1%). An emergency femoral hernia operation was associated with a 10-fold increased mortality risk, whereas the risk for an elective repair did not exceed that of the general population. In elective femoral hernias, laparoscopic (hazard ratio, 0.31; 95% confidence interval, 0.15-0.67) and open preperitoneal mesh (hazard ratio, 0.28; confidence interval, 0.12-0.65) techniques resulted in fewer re-operations than suture repairs. Femoral hernias are more common in women and lead to a substantial over risk for an emergency operation, and consequently, a higher rate of bowel resection and mortality. Femoral hernias should be operated with high priority to avoid incarceration and be repaired with a mesh.

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Hernias are the most common cause of strangulation in patients presenting with small bowel obstruction.

P Modak, A Alani, Jonathan P O'Dwyer … (2006)

Small bowel obstruction (SBO) is a leading cause of admission to surgical emergency units. Strangulation is associated with a 10-fold increase in mortality. The aim of the present study was to identify the most frequent causes of strangulation in patients presenting with small bowel obstruction. A prospective study was conducted of all patients presenting with SBO in one teaching hospital between 2003 and 2004. One hundred and sixty-one patients with symptoms and signs of small bowel obstruction were admitted. Eighty-three were confirmed with contrast studies. The male:female ratio was 1:1.6. The aetiology of obstruction was adhesions in 97 patients (60.2%), hernia in 29 (18%), malignancy in 17 (10.6%) and miscellaneous causes in 18 (11.2%). Operative procedures were performed on 74 patients (46%), 31 of them (42%) with adhesions, 25 (34%) with hernias and 18 (24%) due to other causes. Strangulated bowel occurred in 15 patients (9.3%); 12 had hernias whilst three had adhesions (P < 0.0001). Of the strangulated hernias, ten were femoral, one was inguinal and one was paraumbilical. There were seven deaths; three occurred in patients declared unfit for surgery, while four occurred post-operatively - two had strangulated bowel, the other two had advanced cancer. Whilst adhesions are the most common cause of small bowel obstruction, hernias remain the most frequent cause of strangulation in patients presenting with this condition.

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

T. Jordan, Marc Bjurlin, Carsten Richter … (2010)

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.

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Author and article information

Journal

Journal ID (nlm-ta): World J Emerg Surg

Journal ID (iso-abbrev): World J Emerg Surg

Title: World Journal of Emergency Surgery : WJES

Publisher: BioMed Central

ISSN (Electronic): 1749-7922

Publication date Collection: 2013

Publication date (Electronic): 11 June 2013

Volume: 8

Page: 20

Affiliations

[1 ]Department of General Surgery, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan

[2 ]Division of urology, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan

[3 ]Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, 22110, Jordan

Article

Publisher ID: 1749-7922-8-20

DOI: 10.1186/1749-7922-8-20

PMC ID: 3689056

PubMed ID: 23758812

SO-VID: 24e97706-1d5f-4da9-8c18-3e8b2f2a9da6

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Urinary bladder diverticulum as a content of femoral hernia: a case report and review of literature

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Abstract

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Conclusion

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ScienceOpen Clinical Case Reports Collection

Most cited references 12

Emergency femoral hernia repair: a study based on a national register.

Hernias are the most common cause of strangulation in patients presenting with small bowel obstruction.

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

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