Urinary bladder hernia: through pelvic floor
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At the time the case was submitted for publication Jörgen Strömberg had no recorded disclosures.View Jörgen Strömberg's current disclosures
This patient presented with constipation, fatigue and weight loss. A CT study was carried out to rule out an abdominal malignancy. The patient did not experience, or at least did not express, any symptoms from the urogenitary tract.
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There is a collapse of the left pelvic floor, allowing a big portion of the bladder to descend well below the pubic bone, medial to the gluteal muscles. The rectum and the vagina "rotates" clockwise as they descend, due to traction from the dislocated bladder. However, these structures run separate from each other (thus proving that this is not a prolapse).
This interesting case does not readily fit into any of the more common types of bladder hernias, that usually occur through the inguinal or femoral canal. Nor is it a prolapse, since the vagina can be seen running entirely separate from the bladder.
Interestingly enough this patient seemed to have no symptoms from the hernia, although she literally sits on her own bladder. It is also doubtful whether the hernia has anything to do with the constipation that led her to seek medical advice. There were no findings consistent with abdominal malignancy.
To summarize, this case of urinary bladder herniation, despite its striking radiological appearance, seems to be an incidental finding.
- Bacigalupo LE, Bertolotto M, Barbiera F, Pavlica P, Lagalla R, Mucelli RS, Derchi LE. Imaging of urinary bladder hernias. AJR. American journal of roentgenology. 184 (2): 546-51. doi:10.2214/ajr.184.2.01840546 - Pubmed