PDF(Pubmed)
Abstract：
BACKGROUND: Inguinal herniation of the urinary bladder is uncommon and those descending into the scrotum are even rarer. Although open anterior repair has been used for inguinal bladder hernia, the efficacy of laparoscopic herniorrhaphy has been reported in recent years.
METHODS: A 63-year-old man presented with an irreducible right groin and scrotal bulge associated with voiding difficulty. Abdominal ultrasonography showed a dislocation of the urinary bladder descending into the right scrotum. Abdominal CT imaging revealed that a part of the bladder and small intestine was herniating into the scrotum through the internal inguinal ring and running laterally to the inferior epigastric artery. Under the diagnosis of indirect inguinal bladder hernia, the patient underwent trans-abdominal preperitoneal hernia repair (TAPP). The bladder herniated into the scrotum through the internal inguinal ring was replaced to the original position. Then the myopectineal orifice was exposed and covered with polypropylene mesh, where a horizontal peritoneal incision 4 cm above the hernia orifice, i.e., the high peritoneal incision approach (HPIA), allowed an easy peeling of the peritoneum and hernia sac. The patient\'s postoperative course was uneventful and the voiding difficulty resolved. The patient continued to do well without recurrence at 20 months after surgery.
CONCLUSIONS: Preoperative evaluation with abdominal ultrasonography and CT scan allowed a precise diagnosis of a groin hernia with voiding difficulty. TAPP with HPIA was useful in the treatment of inguinal bladder hernia because this technique facilitated a quick confirmation of the hernia contents, secure dissection of the whole protruded bladder, and adequate replacement of the bladder to the original position without any injury.
METHODS: A 63-year-old man presented with an irreducible right groin and scrotal bulge associated with voiding difficulty. Abdominal ultrasonography showed a dislocation of the urinary bladder descending into the right scrotum. Abdominal CT imaging revealed that a part of the bladder and small intestine was herniating into the scrotum through the internal inguinal ring and running laterally to the inferior epigastric artery. Under the diagnosis of indirect inguinal bladder hernia, the patient underwent trans-abdominal preperitoneal hernia repair (TAPP). The bladder herniated into the scrotum through the internal inguinal ring was replaced to the original position. Then the myopectineal orifice was exposed and covered with polypropylene mesh, where a horizontal peritoneal incision 4 cm above the hernia orifice, i.e., the high peritoneal incision approach (HPIA), allowed an easy peeling of the peritoneum and hernia sac. The patient\'s postoperative course was uneventful and the voiding difficulty resolved. The patient continued to do well without recurrence at 20 months after surgery.
CONCLUSIONS: Preoperative evaluation with abdominal ultrasonography and CT scan allowed a precise diagnosis of a groin hernia with voiding difficulty. TAPP with HPIA was useful in the treatment of inguinal bladder hernia because this technique facilitated a quick confirmation of the hernia contents, secure dissection of the whole protruded bladder, and adequate replacement of the bladder to the original position without any injury.
摘要：
背景：腹股沟膀胱疝并不常见，下降到阴囊的疝更罕见。尽管开放式前路修补术已用于腹股沟膀胱疝，腹腔镜疝修补术的疗效近年来已有报道。
方法：一名63岁的男子表现为右腹股沟和阴囊隆起，伴有排尿困难。腹部超声检查显示膀胱脱位下降到右阴囊中。腹部CT成像显示，膀胱和小肠的一部分通过腹股沟内环突出到阴囊中，并横向延伸到上腹部下动脉。在腹股沟斜疝的诊断下，患者接受了经腹腹膜前疝修补术(TAPP).通过腹股沟内环突出进入阴囊的膀胱被替换为原始位置。然后将肌外口露出并用聚丙烯网覆盖，在疝气口上方4厘米的水平腹膜切口，即，高位腹膜切口入路（HPIA），允许腹膜和疝囊容易剥离。患者术后病程顺利，排尿困难得到解决。手术后20个月，患者病情持续良好，无复发。
结论：术前评估腹部超声和CT扫描可以准确诊断腹股沟疝并有排尿困难。TAPP与HPIA在腹股沟膀胱疝的治疗中很有用，因为这种技术有助于快速确认疝内容物。安全解剖整个突出的膀胱，并将膀胱充分置换到原来的位置，没有任何损伤。
方法：一名63岁的男子表现为右腹股沟和阴囊隆起，伴有排尿困难。腹部超声检查显示膀胱脱位下降到右阴囊中。腹部CT成像显示，膀胱和小肠的一部分通过腹股沟内环突出到阴囊中，并横向延伸到上腹部下动脉。在腹股沟斜疝的诊断下，患者接受了经腹腹膜前疝修补术(TAPP).通过腹股沟内环突出进入阴囊的膀胱被替换为原始位置。然后将肌外口露出并用聚丙烯网覆盖，在疝气口上方4厘米的水平腹膜切口，即，高位腹膜切口入路（HPIA），允许腹膜和疝囊容易剥离。患者术后病程顺利，排尿困难得到解决。手术后20个月，患者病情持续良好，无复发。
结论：术前评估腹部超声和CT扫描可以准确诊断腹股沟疝并有排尿困难。TAPP与HPIA在腹股沟膀胱疝的治疗中很有用，因为这种技术有助于快速确认疝内容物。安全解剖整个突出的膀胱，并将膀胱充分置换到原来的位置，没有任何损伤。
