37 KSÜ Tıp Fak Der 2019;14(1) KSU Medical Journal 2019;14(1) 37-38 37-38 İnguinal Herniasyonun Nadir Bir Nedeni: Mesane Hernisi A Rare Cause of Inguinal Herniation: Bladder Herniation Sefa TÜRKOĞLU1, Cihan BEDEL2 1 Uzman Dr. Denizli Devlet Hastanesi, Radyoloji Kliniği, DENİZLİ 2 Uzman Dr. Sağlık Bilimleri Üniversitesi, Antalya Eğitim ve Araştırma Hastanesi, Acil Tıp Kliniği, Kazım Karabekir Caddesi, 07100, Muratpaşa, ANTALYA Öz Mesanenin inguinal hernisi, inguinal herni vakaların yak- laşık % 1-3’ünde görülen bir durumdur. Çoğu asemptomatiktir, an- cak dizüri, ani ve şiddetli idrar yapma isteği, noktüri ve hematüri gibi semptomlar da görülebilmektedir. Bilgisayarlı tomograf, herniasyon detaylarını detaylandırmak için en iyi görüntüleme seçeneğidir. Bu çalışma, inguinal mesane herniasyonu için acil hekimlerini bilinçlendirmeyi ve yanlış tanıyı önlemeyi amaçlamaktadır Anahtar Kelimeler: Mesane herniasyonu, inguinal herni, inguinal şiş- lik Abstract Urinary bladder presenting as an inguinal hernia is an un- common condition found in about 1-3% of inguinal hernia. Most are asymptomatic, but symptoms such as dysuria, urgency, nocturia and haematuria can be seen. Computed tomography seems the best imag- ing choice to outline the details of herniation. Tis study aims to raise awareness for emergency physicians for the inguinal bladder hernia- tion and to avoid misdiagnosis. Key Words: Bladder herniation, inguinal hernia, inguinal swelling Case Report (Olgu Sunumu) INTRODUCTION Herniation of the urinary bladder is a rare, with reported incidence of about 1 to 3% cases of inguinal hernia. It occurs in 10% of men over 50 years old (1). Most are asymptomatic, but symptoms such as dysuria, frequency, urgency, nocturia and haematuria are also common. A typical symptom will be a reduction of hernia size afer passing urine, and the ability to pass urine afer pressing the hernia sac (1,2). We are presenting a case with a inguinal bladder hernia (IBH) as a relatively rare entity, its unique presentation, for general awareness in hernia surgery. Tis study aims to raise awareness for emergency physicians for the IBH and to avoid misdiagnosis. CASE REPORT A 58-year-old man presented to hospital with 1-month history of lef groin pain, intermittent dysuria and swelling. Four days prior to the swelling had become painful. He reported nausea, vomiting, dificulties with micturition and denied fever. Physical examination lef direct inguinal hernia was present, which reduced on manipulation. His past medical history was unremarkable. On admission, his temperature was 37.2°C, his heart rate was 82 beats/min, his respiratory rate was 16 breaths/ min and his blood pressure was 110/70 mmHg. Te laboratory test results on admission were within the normal limits except microhematuria. Computed tomography (CT) revealed a lef inguinal hernia with fuid density lesion continuous with lef lateral bladder wall (Figure 1). Herniation of the bladder and continuity of the lesion with bladder wall was better demonstrated on sagittal and coronal reformatted images (Figure 2). No bowel/omentum was contained in the hernia. Bilateral kidneys were normal. Diagnosis of lef IBH as content was made. Patient was then referred to surgery department for further management. Figure 1: Axial CT scan shows lateral deviation of the lef la- teral wall of the urinary bladder (arrow), which is pointing towards inguinal canal. Figure 2: Sagittal reconstructed images better demonstrates the herniation of the bladder into the inguinal canal (arrow) DISCUSSION Urinary bladder can make herniation into the inguinal canal or scrotum. Tis can also be called a “scrotal cystocele”. It is found in 1-3% of inguinal hernias and and incidence is higher (about 10%) in obese males, aged ≥50 years (3). Te ureters can İletişim: DOI: Dr. Cihan Bedel, Sağlık Bilimleri Üniversitesi, Antalya Eğitim ve Araştırma Hastanesi, Acil Tıp Kliniği, Antalya 10.17517/ksutfd.452433 Tel : E-Posta : Geliş Tarihi : Kabul Tarihi : 0 507 5641254 cihanbedel@hotmail.com 09. 08. 2018 15. 10. 2018