Complete inguinal bladder hernia causing acute right upper urinary tract obstruction

Abstract

Case Summary: An 86-year-old male nursing home resident presented with increasing confusion and was initially treated for catheter-associated urinary tract infection. Computed tomography (CT) scan demonstrated complete inguinal bladder hernia with compression of the right vesico-ureteric junction leading to acute obstructive renal failure. Percutaneous nephrostomy was attempted but was not possible due to patient non-compliance. Patient improved with conservative management. Discussion: Bladder involvement in inguinal hernia is rare with most cases being identified at the time of hernia repair and there is a 17% risk of intra-operative bladder injury. Key risk factors include increasing age, male gender, lower urinary tract symptoms and previous hernia repair. Percutaneous nephrostomy followed by inguinal hernia repair is the treatment of choice for most patients. This case highlights that inguinal bladder hernia can lead to acute upper urinary tract obstruction even when the bladder is catheterised. Level of evidence: IV