933 Inguinal Bladder Hernia: Case Report and Literature Review

Background

Partial bladder herniation into the inguinal canal has an incidence of 1-3%. Most patients are asymptomatic, and diagnosis is made incidentally upon imaging or during surgical repairs. Complete herniation of the bladder and distal ureters is rare, and few cases of resultant acute kidney injury or hyperkalaemia have been reported. This case presentation includes preoperative and intra-operative images, and literature review.

Case presentation

A 73-year-old gentleman with longstanding bilateral inguinal hernia, benign prostatic hyperplasia, type 2 diabetes mellitus, and obesity presented with new-onset lower urinary tract symptoms and intermittent pain over his right inguinal hernia. His PSA (Prostate-Specific Antigen) was raised, and imaging identified bilateral hydronephrosis, and right inguinal hernia containing distal ureters and bladder. He was added to the waiting list for elective hernia repair.

Whilst awaiting repair, he was admitted with acute kidney injury and hyperkalaemia, which was managed with cardiac protection, urethral catheterisation, hydration, and serial blood tests. After stabilization, he underwent an open right inguinal hernia repair with mesh. His acute kidney injury resolved; however he failed trial without catheter (TWOC), and was discharged with a catheter pending TWOC clinic review. General Surgical Follow up is planned to discuss left inguinal hernia repair.

Conclusion

Awareness of bladder herniation into the inguinal canal is essential to avoid iatrogenic injury. Careful pre-operative planning and correction of physiological abnormalities is vital to ensure good surgical outcome. More unusual sequelae of untreated hernias are likely to become more frequent, if fewer elective hernias are performed.