Case presentation
An 81-year-old man presented with a one-day history of fever. He experienced a urinary tract infection (UTI) two months ago. He did not complain of other symptoms, including abdominal or flank pain, dysuria, or feeling of residual urine. His past medical history included atrial fibrillation, chronic heart failure, and femoral-femoral bypass for external iliac artery occlusive disease. His body temperature was 38.5°C. There was a right swollen groin and scrotum without tenderness. Blood test and urinalysis revealed elevated c-reactive protein level and bacteriuria. Abdominal computed tomography (CT) without contrast showed the perirenal fat stranding and a bladder hernia which herniated into the scrotum (Fig. 1a,1b. Arrow indicates a bladder hernia). There was no ureteral stone and significant prostatic hyperplasia. Urine culture detected Escherichia coli. He was diagnosed with UTI and was started on ampicillin. His fever subsided on the second day, and antimicrobial therapy was completed in 10 days. Considering the bladder hernia as a trigger for UTI because of the history of recurrent UTI without other etiologies than bladder hernia, a urologist was consulted to manage the bladder hernia. Surgery was planned but not performed because the patient eventually declined. The patient was discharged and had not experienced any recurrence of fever so far. (The patient's consent for the case report was obtained after being well informed.)
Discussion
Bladder hernias occur in approximately 1-4% of inguinal hernias.
1
Bladder hernias that descend into the scrotum, called scrotal cystoceles, are thought to be even rarer.2
Inguinal swelling, lower urinary tract symptoms, pain, and reduction of inguinal swelling after urination have been reported as symptoms, but some people have no symptoms.3
Complications of inguinoscrotal bladder hernias may include obstructive uropathy and bladder infarctions.1
It is also known to cause UTI.1
In this case, the patient had no LUTS (lower urinary tract symptoms) but had developed repeated UTI without other triggers, which were thought to be due to bladder herniation. The case highlights that clinicians need to consider the possibility of bladder hernias as an underlying cause of UTI, although it is uncommon.Funding source
None.
Declaration of Competing Interest
All authors declare no conflict of interest.
All authors had access to the data. Tetsu Sakamoto wrote the initial draft, and Taro Shimizu revised the manuscript.
References
- Inguinoscrotal bladder hernias: report of a series and review of the literature.Can Urol Assoc J. 2008; 2: 619-623
- Scrotal cystocele.J Am Med Assoc. 1951; 147: 1439-1441
- Diagnosis and treatment of inguinal hernia of the bladder: a systematic review of the past 10 years.Turk L Urol. 2018; 44: 384-388
Article info
Publication history
Published online: September 27, 2022
Accepted:
September 22,
2022
Received:
November 17,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
00427-X&id=gr1.jpg){kind=link}