Partial Cystectomy in Sliding Inguinal Hernia with Bladder Gangrene: A Case Report

A sliding hernia is in which one or more organ contents in the body cavity spread simultaneously with the hernia sac into another body cavity. In some cases, sliding inguinal hernia may involve the bladder herniating along with the inguinal hernia sac, which is more commonly diagnosed intraoperatively. The incidence rate is less than 4% of all inguinal hernia cases.

We report a case of an 83-year-old man who presented with a painful lump on the crease of both thighs with lower urinary tract symptoms. In the middle of surgery, strangulation of the bladder was found together with extensive, poorly demarcated bladder tissue necrosis and few healthy surrounding tissues. Partial cystectomy was performed by excising the affected bladder, leaving the healthy bladder. Finally, the bladder was sutured with absorbable suture, and a 16 Fr Foley urinary catheter was placed through the urethra. Hernioplasty was continued until all of the layers were sutured completely. 

Sliding inguinal hernia with bladder involvement is still challenging to date as it can only be recognized intraoperatively. If there is urinary tract organ involvement, especially in the bladder, management in urology needs to be carried out from the beginning.