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ncarcerated Vesicoinguinal Hernia Presenting with Gross Hematuria

ergio Huerta, MD, Timothy Fairbanks, MD, Marianne Cinat, MD, FACS

niversity of California, Irvine Medical Center, Orange, CA

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55-year-old man (BMI 40.2 kg/m2) presented to themergency department with complaints of gross hema-uria and a large left inguinoscrotal mass. For the past 3ears he required manual compression of his scrotum torinate; in the morning before admission, gross hema-uria developed. Physical examination revealed a large,ontender, incarcerated inguinoscrotal hernia and a re-racted penis (A). Placement of a Foley catheter pro-uced 200 mL of gross blood. A CT cystogram examithout oral contrast showed the entire bladder incar-

erated in the inguinoscrotal hernia (B). There was noxtravasation of contrast. Blood clots were noted in theependent portions of the bladder (B, arrow).

9922005 by the American College of Surgeons

ublished by Elsevier Inc.

In the operating room, a large direct defect was iden-ified. The entire bladder was incarcerated (C) and mas-ively distended, and reduction was unsuccessful. Thencision in the inguinal canal was extended medially byransecting the conjoined tendon. This allowed for re-uction of the bladder into the pelvis. The inguinal flooras then repaired (D, CS � cord structures; IL � ingui-al ligament; M � mesh).Postoperatively, he had a normal scrotum with the

enis in its normal anatomic position, and his hematuriaesolved within 12 hours. A postoperative CT urogramemonstrated normal ureters (E, arrows) and the blad-er in the pelvis.

ISSN 1072-7515/05/$30.00doi:10.1016/j.jamcollsurg.2005.04.037

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993Vol. 201, No. 6, December 2005 Huerta et al Images for Surgeons

Vesicoinguinal hernias (VIH) comprise 1% to 4% ofll inguinal hernias, but herniation of the entire bladderas only been reported in 150 cases.1,2 VIH typicallyccurs in older (�50 years), obese, male patients. Theyre often asymptomatic, commonly diagnosed at theime of inguinal herniorrhaphy.

Patients with VIH have an 8% risk of bladder cancer.ther urologic findings include benign prostate hypar-

lasia, hydronephrosis, lithiasis in the herniated bladder,esicouretheral reflux, necrosis of the bladder and scrotalbscess.2 Gross hematuria in patients with VIH has noteen reported, and it is unclear why it occurred in this

atient. No mucosal abnormalities were noted during

ystoscopy and the hematuria completely resolved aftereduction of the hernia.

Complete herniation of the bladder is uncommon fornguinal hernias. VIH can be repaired by the standard in-uinal hernia incision. Urologic investigation is requiredoncurrent with or after reduction and repair of VIH.

EFERENCES

. Catalano O. US evaluation of inguinoscrotal bladder hernias:report of three cases. Clin Imaging 1997;21:126–128.

. Oruc MT, Akbulut Z, Ozozan O, Coskun F. Urological findingsin inguinal hernias: a case report and review of the literature.

Hernia 2004;8:76–79.