Giant vesico-scrotal hernia

Case contributed by Dr Wael Nemattalla

Patient Data

Gender: Male
Modality: Fluoroscopy

Urinary bladder herniated into the scrotal sac is seen, with trabeculations in urinary bladder, and left sided vesicoureteric reflux

Case Discussion

Pearls for urinary bladder (UB) hernia:

  1. UB hernias in general are NOT rare
  2. Scrotal hernia is called "scrotal cystocele"
  3. Most bladder hernias involve the inguinal and femoral canals.
  4. Femoral UB hernia is more frequent in women.
  5. Other sites for UB hernia include: ischiorectal, obturator, and abdominal wall openings.
  6. The hernia may simply represents UB diverticulum.
  7. "Bladder ears" are protrusion of the lateral aspect of the UB that are normal (and incidental finding) in young infants due to large inguinal canals.
  8. Oblique projections are valuable for displaying vesical scrotal hernia.
  9. Hernias may increase in size after Valsalva maneuver.
  10. Hernia may only be clear at post-voiding films.
  11. Changing volume after micturition is diagnostic of bladder scrotal hernia.
     

Risk factors include for UB hernia: 

  • UB outlet obstruction
  • pericystitis
  • obesity
  • space occupying pelvic masses
     

Types of UB hernia:

  • para-peritoneal, most frequent
  • extraperitoneal without peritoneal attachment
  • intraperitoneal: UB completely covered by peritoneum

Tips:

  1. Giant scrotal bladder hernia by itself is rare.
  2. Dumbbell-shaped UB has been described as in our case.
  3. In our case there is bladder trabeculations consistent with UB outlet obstruction. 
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Case Information

rID: 10428
Case created: 12th Aug 2010
Last edited: 13th Nov 2015
System: Urogenital
Inclusion in quiz mode: Included

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