Giant vesico-scrotal hernia
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Urinary bladder herniated into the scrotal sac is seen, with trabeculations in urinary bladder, and left sided vesicoureteric reflux
Pearls for urinary bladder (UB) hernia:
- UB hernias in general are NOT rare
- Scrotal hernia is called "scrotal cystocele"
- Most bladder hernias involve the inguinal and femoral canals.
- Femoral UB hernia is more frequent in women.
- Other sites for UB hernia include: ischiorectal, obturator, and abdominal wall openings.
- The hernia may simply represents UB diverticulum.
- "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.
- Oblique projections are valuable for displaying vesical scrotal hernia.
- Hernias may increase in size after Valsalva maneuver.
- Hernia may only be clear at post-voiding films.
- Changing volume after micturition is diagnostic of bladder scrotal hernia.
Risk factors include for UB hernia:
- UB outlet obstruction
- space occupying pelvic masses
Types of UB hernia:
- para-peritoneal, most frequent
- extraperitoneal without peritoneal attachment
- intraperitoneal: UB completely covered by peritoneum
- Giant scrotal bladder hernia by itself is rare.
- Dumbbell-shaped UB has been described as in our case.
- In our case there is bladder trabeculations consistent with UB outlet obstruction.