A rare intraperitoneal inguinal bladder hernia (IBH) in a 58-year-old Indonesian male: A case report and review of the literature

Introduction and importance: Inguinal bladder hernia (IBH) accounts for <5 % of inguinal hernias. As to our knowledge, this is the first case report of a rare intraperitoneal IBH in Indonesia.

Case report: Here we present a case report of a 58-year-old Indonesian male complaining of a groin mass on the right side since 1 year ago, accompanied by lower urinary tract symptoms (LUTS), two-stage micturition, lower abdominal discomfort and pain during urinating and coughing. Ultrasound revealed widened inguinal canal containing peritoneum and "teardrop" lesion at the inguinal continuing until the right scrotal. The patient was scheduled for open repair of inguinal hernia (herniorrhaphy) with tension-free mesh. Intraoperative findings include the entire bladder herniation located at intraperitoneal.

Clinical discussion: Symptoms of IBH include inguinal or scrotal swelling with or without pain, LUTS, two-stage micturition, to various symptoms owing to complications. Pre-operative imaging might help to confirm diagnosis. The definitive treatment of IBH is either reduction or resection of the herniated bladder followed by surgical repair (herniorrhaphy).

Conclusion: IBH is rare but should be suspected in older males (≥50 years old), individuals with weak abdomino-pelvic musculature, and obesity. Pathologies of the bladder, such as bladder outlet obstruction (BOO), chronically distended bladder, and decreased bladder tone related to benign prostate hyperplasia (BPH) or bladder neck stricture can also increase risk of IBH. Treatment with open repair of inguinal hernia (herniorrhaphy) with tension-free mesh is the most common and preferred surgical approach.