Urinary tract infection due to herniation of bladder

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 (Figure 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.)