Symptomatic inguinal bladder hernia causes post-renal acute kidney injury: A rare case report

INTRODUCTION: Inguinal bladder hernia (IBH) is a rare condition representing less than 5% of all inguinal hernias. Most cases occur in elderly overweight men. Patients may present with variable symptoms such as urinary symptoms, inguinal swelling, or pain; however, most of them are asymptomatic and only less than 7% are diagnosed pre-operatively. Different radiological studies can be used if IBH suspected preoperatively including ultrasound, computed tomography scan; however, cystography is the most sensitive test for diagnosis of IBH. Open reduction and hernia repair are the standard treatment of IBH. CASE PRESENTATION: We report a rare case of an-83-year-old male who presented with left inguinal pain associated with lower urinary tract symptoms including dysuria, nocturia, post-voidal dribbling, and urinary frequency. Laboratory studies showed acute kidney injury (AKI), and computed tomography (CT) of abdomen and pelvis without contrast CT revealed a herniation of 80% of the bladder through the left inguinal canal into the left scrotal sac, with moderate bilateral hydronephrosis and hydroureter, though no obstructing calculi are seen. Pre-operative diagnosis of incarcerated inguinal bladder hernia (IBH) was made, and a timely surgical intervention preceded by bladder catheterization led to a significant improvement of AKI and an excellent outcome without post-operative complications. DISCUSSION AND CONCLUSION: IBH is uncommon condition that can present with non-specific urinary symptoms; therefore, high index of suspicion is mandated for diagnosis especially in patients with risk factors. Pre-operative radiological evaluation to avoid iatrogenic bladder injury with subsequent surgical repair is the standard management for IBH as we accomplished in our case.