以尿滯留表現的腹股溝滑動疝氣:影像學診斷之罕見案例
林毓庭、林克勳、李良明、溫玉清、林雍偉、蕭志豪、石宏仁、許軒豪
台北市立萬芳醫院 泌尿科
Sliding inguinal hernia presenting with urine retention: a rare case diagnosed with imaging
Allen Yu Ting Lin, Ke-Hsun Lin, Liang-Ming Lee, Yu-Ching Wen, Yung-Wei Lin, Hung-Jen Shih, Chi-Hao Hsiao
Department of Urology, Wan Fan Hospital, Taipei Medical University, Taipei, Taiwan
Introduction
Inguinal hernia is a common abdominal wall defect disease and open surgical repair is often done without needing any pre-operation imaging evaluation. Hernia is often associated with protruding mass but not commonly associated with lower urinary tract symptoms. Thereby, we are presenting a case with sliding inguinal hernia with urine retention and diagnosed clinically with imaging study.
Case presentation
A 66 year-old male suffered from weak stream, hesitancy, and intermittent urine retention for about 5 years. Patient acknowledged urine retention and was treated with medication initially. However, symptoms progress and intermittent catheterization was required to evacuate urine. Thus, abdominal and pelvis computer tomography (CT) was arranged and showed right inguinal hernia with herniation of part of urinary bladder. In addition to that, cystography also showed right urinary bladder with herniation. Direct type of right inguinal hernia was note during surgery with part of urinary bladder protruding through the weakness of fascia transversalis. The Bassini hernioplasty was done without evidence of bladder injury.
Discussion
Sliding hernias are those in which part of the sac wall is formed by a viscus and bladder variant is found in about 3% of inguinal hernias. Prevalence of bladder variant increase proportionally with age and male is more common likely due to the distal obstruction. Most of the time, bladder herniation does not cause any symptom but urinary retention has been reported in numerous case and so as this case. Thus, imagine was used pre-operatively to help with the diagnosis.
Conclusion
Physicians treating inguinal hernia should be aware with sliding variant when an elderly male presents inguinal mass with urine retention. Imagine can be done prior to surgery for diagnosis and prevent intra-operative injury.