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Middle aged man with groin pain

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Q1: What abnormality is shown and what is the diagnosis?

We can see a contrast filled oblong sac on the left inguinal region (fig 1; see p 179). This is herniation of the bladder in forming the wall of the direct inguinal hernia.1,2

Q2: How do you manage this problem?

The management of this condition is in two parts:

(A) Repair of the inguinal hernia, which is the main cause of the pain, using a form of wire mesh to reinforce the posterior wall of the inguinal canal to prevent recurrence of the hernia.1

(B) Repair of the bladder diverticulum by open diverticulectomy or laparoscopic diverticulectomy.3,4

Q3: What complications may arise during the management of such patients?

If the surgeon is unaware of the possibility of herniated bladder forming hernial sac, the bladder may be inadvertently damaged during the hernia repair.

Discussion

This is a rare condition where there is herniation of the bladder in forming the wall of the direct inguinal hernia,1 and only about 100 cases have been reported world wide.5,6

The treatment of this condition depends on the diagnosis and divided into two parts: repair of the hernia and repair of the diverticulum (see answer to question 2 above).

Final diagnosis

Herniation of the bladder.

References

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