以腹腔鏡腹膜外技術修補巨大腹股溝膀胱疝氣－罕見手術病例報告

吳冠賢13, 溫聖辰13, 李經家123

高雄醫學大學附設中和醫院 泌尿部1、高雄醫學大學醫學系 泌尿學科2、高雄醫學大學 臨床醫學研究所３

Extraperitoneal laparoscopic repair of huge inguinoscrotal bladder hernia: a case report and literature review

Hao-Han Chang13, Shen-Chen Wen13, Ching-Chia Li123

1Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

2Department of Urology, School of Medicine, College of Medicine, KaohsiungMedical University, Kaohsiung,

3Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung MedicalUniversity, Kaohsiung, Taiwan

Purpose:

Bladder, despite approaching to inguinal region, rarely drops into inguinal canal causing bladder herniation. Bladder herniation only accounted for 1-3% of all inguinal herniation, while the incidence may reach up to 10% among obese patient over 50 years old. We reported a 82-year old patient suffered from inguinal bladder hernia treated with Extraperitoneal laparoscopic repair.

Case report:

A 82-year-old man with chronic urinary frequency and incomplete voiding presented fever and chillness for 3 days. Kidney echo revealed bilateral hydronephrosis and hydroureter. Urinary tract infection and acute kidney injuries were diagnosed by blood exam and urine analysis. Foley catheter was placed in order to relieve his voiding symptoms. Computed tomography revealed right inguinoscrotal hernia containing a great portion of bladder (Panel A, arrow), while bilateral ureterovesical junction were stuck inside the scrotum, resulting in bilateral hydronephrosis and hydroureter. We arranged total extraperitoneal laparoscopic inguinal hernia repair. During operation, right direct type inguinoscrotal bladder hernia was discovered (Panel B, arrow), while left side direct type inguinal hernia was also noted. After gently pulled the hernia sac and the bladder, we placed an anatomical mesh at each side to fill up the defect.

Conclusion:

Herniation of bladder is a rare clinical condition, consisting of potentially prominent complication, hiding in a very common surgical indication－inguinal herniation. Detailed history and examination for exact diagnosis are extremely important. While most of the previous reports suggested open approach as the way of surgical repair, we confirmed that these situations might be managed safely by laparoscopic total extraperitoneal approach. Laparoscopic approach offers similar surgical outcome as well as better visibility and improved cosmesis.