Case reportInguinal herniation of a bladder diverticulum
Introduction
The occurrence of a hernia in the adult population is frequent [1], and its contents are usually abdominal viscera surrounded by the peritoneum. An extraperitoneal organ cannot be contained in the sac of the hernia; however, it can be pulled into it by the sac itself, becoming a component of the hernia, as in the case of a bladder diverticulum. This occurs rarely, statistically ranging between 0.36% [2] and 1% to 3% [3] of hernias. The authors present two cases of hernias containing a diverticulum of the bladder.
Section snippets
Case 1
A patient aged 80 years is admitted to the emergency department because of bilateral varicose ulcers and edema of the lower limbs. Clinical examination shows an increase in the volume of the scrotum and edema of the penis. Biological examination shows leukocytosis; other findings were within the normal limits.
The patient's clinical history disclosed atrial fibrillation and hypertension, which was responsible for cardiac insufficiency, and bilateral hip prosthesis. In 2001, the patient was
Case 2
An afebrile patient 70 years of age was admitted to hospital because of abdominal pain. The patient's clinical history was negative for symptoms related to the urogenital system.
Abdominal–pelvic CT performed to demonstrate the cause of the abdominal symptoms showed no lesions in the abdominal cavity; however, it incidentally demonstrated a right inguinal fluidal mass with thick walls (Fig. 2A), corresponding to a bladder diverticulum, confirmed by delayed scans, following an intravenous
Discussion
The incidence of inguinal hernia in the adult is high, involving, in particular, the male sex (27% vs. 3%, male vs. female) [1], and is secondary to a weakness in the Hesselbach's triangle.
The pectineal–muscular orifice of the groin is limited by an osteomuscular wall and is separated into two segments by the inguinal ligament. This orifice is closed by the fascia transversalis, which forms the deep posterior floor of the inguinal walls. The rupture, dehiscence, or pushing aside of this wall is
Conclusion
The presence of a bladder diverticulum in an inguinal hernia is a rare event. In most cases, it occurs in an acquired direct inguinal hernia with the bladder pulled into the hernia together with a sheath of peritoneum, which will form its sac. This type of hernia can be associated with an indirect or a controlateral hernia. AngioCT is the imaging of choice because it provides information on the location and contents of the hernia, demonstrates possible associated abdominal lesions, and
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