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Direct inguinal hernia containing bladder carcinoma: A case report and review of the literature.
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MedLine Citation:
PMID:  24632299     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Inguinal hernia containing bladder carcinoma is a very rare occurrence.
PRESENTATION OF CASE: We report a case of a male patient who presented with a left groin hernia containing an irregular mass. The hernia was repaired without the use of mesh and a partial cystectomy was done.
DISCUSSION: Only 1-3% of all inguinal hernias involve the bladder, with very few reports containing a carcinoma.
CONCLUSION: Treatment consists of removing the tumor and repairing the hernia.
Authors:
Anastasios Katsourakis; George Noussios; Christos Svoronos; Michael Alatsakis; Efthimios Chatzitheoklitos
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Publication Detail:
Type:  Journal Article     Date:  2014-02-15
Journal Detail:
Title:  International journal of surgery case reports     Volume:  5     ISSN:  2210-2612     ISO Abbreviation:  Int J Surg Case Rep     Publication Date:  2014  
Date Detail:
Created Date:  2014-04-07     Completed Date:  2014-04-07     Revised Date:  2014-04-11    
Medline Journal Info:
Nlm Unique ID:  101529872     Medline TA:  Int J Surg Case Rep     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  180-2     Citation Subset:  -    
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Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Journal Information
Journal ID (nlm-ta): Int J Surg Case Rep
Journal ID (iso-abbrev): Int J Surg Case Rep
ISSN: 2210-2612
Publisher: Elsevier
Article Information
© 2014 The Authors
open-access:
Received Day: 6 Month: 10 Year: 2013
Revision Received Day: 12 Month: 1 Year: 2014
Accepted Day: 13 Month: 1 Year: 2014
pmc-release publication date: Day: 15 Month: 2 Year: 2014
Electronic publication date: Day: 15 Month: 2 Year: 2014
collection publication date: Year: 2014
Volume: 5 Issue: 4
First Page: 180 Last Page: 182
PubMed Id: 24632299
ID: 3980519
Publisher Id: S2210-2612(14)00012-1
DOI: 10.1016/j.ijscr.2014.01.007

Direct inguinal hernia containing bladder carcinoma: A case report and review of the literature
Anastasios Katsourakisa
George Noussiosb Email: geornous@hotmail.com
Christos Svoronosa
Michael Alatsakisa
Efthimios Chatzitheoklitosa
aDepartment of General Surgery “Agios Dimitrios” General Hospital, Thessaloniki, Greece
bLaboratory of Anatomy of Department of Physical Education (at Serres), Aristotle University of Thessaloniki, Greece
Corresponding author at: Laboratory of Anatomy of Department of Physical Education (at Serres), Aristotle University of Thessaloniki, Vassileos Georgiou A’, 34, 546.40 Thessaloniki, Greece. Tel.: +30 2310855012. geornous@hotmail.com

Introduction

Minor bladder shift plus inguinal hernia is a relatively rare condition that occurs in only 1–3% of hernias and up to 10% of men over 50 years of age.1 Tumors in inguinal hernias are unusual. Only 22 cases of neoplasm arising within a vesical hernia are cited in published reports. We present a case of a papillary urothelial bladder carcinoma in a direct inguinal hernia.


Presentation of case

A 79-year-old man presented to our department with a swelling in the left groin evolving over 10 years without any symptoms. He had undergone right inguinal herniorrhaphy 53 years ago. The patient was operated using the transurethral resection of bladder tumor (TUR-BT) technique 3 months before due to papillary urothelial carcinoma of the prostatic part of the urethra. The physical examination revealed a large painless mass in the left groin. The ultrasound examination was inconclusive showing only a left inguinal hernia while the intravenous pyelography revealed an abnormal position of the urinary bladder. The computed tomography (CT) (Fig. 1) showed a left groin hernia with an irregular mass content which grows from the urinary bladder (probably tumor of the bladder wall). The patient underwent open surgery via an inguinal approach; the tumor was palpated in the herniated portion of the bladder (Fig. 2). A partial cystectomy was done and the inguinal hernia was repaired without the use of mesh. Pathologic examination of the specimen reported a tumor of 8 cm × 5 cm × 5 cm (Fig. 3). The microscopic study (Fig. 4) revealed a high-grade carcinoma with necrosis and characteristics of a papillary urothelial carcinoma with invasion of 1/3 of the muscularis propria (T2a). The postoperative period was uneventful. One year after the operation the patient presented no recurrence of the tumor or hernia.


Discussion

Various studies have reported that 1–3% of all inguinal hernias involve the bladder. Some researchers have estimated the prevalence may be closer to 10% in men.1

According to the relationship with the peritoneum, the hernias are classified as follows: (a) paraperitoneal, which are common (60%) in which the peritoneum covers the external aspect of the herniated bladder, can be direct or indirect, as it was in our case; (b) extraperitoneal, in which the tumors do not cover the peritoneum and are usually small; and intraperitoneal, in which the peritoneum covers the entire portion of herniated bladder.2,3

The most common etiologies of bladder hernias are: obesity, weakness of the pelvic wall, bladder outlet obstruction, and decreased tone of the bladder. In our case the patient had a history of hernia repair 53 years ago, however, whether a history of herniorrhaphy affects the occurrence of bladder hernia is uncertain.4,5

Bladder hernias are usually asymptomatic but are often associated with intermittent swelling in the groin and significant lower urinary tract symptoms. In cases of large hernias the patients typically present with two-stage micturition, involving spontaneous bladder emptying with a second stage manual compression of the hernia.6

The differential diagnosis includes: bladder diverticulum, hernia of a mesenteric cyst, hydrocele and spermatic cord cyst.

The radiological diagnosis can be established by cystography, ultrasonography, and intravenous pyelography or computed tomography.1

The numbers of cases of hernia which contain a tumor of the urinary bladder being published are low (Table 1).

The purpose of treatment is to remove the tumor, repair the hernia and correct the obstructive condition of any lower urinary tract. The patient survival is low due to the delay and difficulty in obtaining an accurate diagnosis. Despite the overall poor prognosis the outcome depends on the histologic type and stage regardless of the diagnostic delay.7


Conclusion

Inguinal bladder hernias are relatively uncommon, with few (22) reports of tumor in the herniated bladder have been published in the international literature (Medline/Pubmed). The surgical management consists of removing the herniated bladder tissue containing the tumor with a marginal of safety, and repairing the hernia, with careful urological follow up.


Conflict of interest

The authors report no conflict of interest.


Funding

None.


Ethical approval

Written informed consent was obtained from the patient of the publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal of request.


Author contributions

Anastasios Katsourakis participated in the design of the study and drafted the manuscript; George Noussios participated in the coordination and helped to draft the manuscript; Christos Svoronos performed the literature review; Michael Alatsakis helped to draft the manuscript; Efthimios Chatzitheoklitos participated in the coordination.


Notes

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

References
1. Epner S.L.,Rozenblit A.,Gentile R.. Direct inguinal hernia containing bladder carcinoma: CT demonstrationAm J Roentgenol161Year: 199397988517332
2. Escudero J.U.,De Campos M.R.,Dominguez F.O.. Hernias vesicales inguinoescrotalesArch Esp Urol60Year: 200723123617601297
3. Sanchez C.,Olmedo E.J.,Murillo S.R.. Hernia vesical inguinoescrotal gigante, Caso clinico y revision de la literaturaActas Urol Esp25Year: 200131531911455837
4. Bisharat M.,Donnell M.E.,Thomson T.. Complications of iguinoscrotal bladder hernias: a case seriesHernia13Year: 2009818418553121
5. Kim K.H.,Lee S.W.,Hur D.S.. Massive inguinal bladder hernia into the scrotumKorean J Urol42Year: 200110111012
6. Kraft K.H.,Sweenney S.,Fink A.S.. Inguinoscrotal bladder hernias: report of a series and review of the literatureCan Urol Assoc J2Year: 200861962319066682
7. Navarro H.P.,Ruiz J.M.,Lopez P.C.. Tumor inside an iguinoscrotal bladder herniaArch Esp Urol63Year: 201047147620820087

Article Categories:
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Keywords: Keywords Inguinal hernia, Bladder carcinoma.

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