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Gross hematuria as the presentation of an inguinoscrotal hernia: a case report.

Ansari K, Keramati MR, Rezaei Kalantari K, Jafari M, Godazandeh G, Pakzad M - J Med Case Rep (2011)

Bottom Line: On further evaluation, computed tomography confirmed that his sigmoid colon was the source of the pressure effect on his bladder, resulting in hydroureteronephrosis and hematuria.No tumoral lesion was evident.Herniorrhaphy led to the resolution of his signs and symptoms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Firoozgar Hospital, Tehran University of Medical Sciences, Tehran, Iran. kayvanansari@yahoo.com.

ABSTRACT

Introduction: Several complications have been reported with inguinal hernias. Although hematuria and flank pain, either as the presentation or as a complication of inguinal hernia, are infrequent, this condition may lead to the development of obstructive uropathy, which can have diverse manifestations.

Case presentation: A 71-year-old Iranian man with Persian ethnicity presented with new onset episodes of gross hematuria and left-sided flank pain. A physical examination revealed a large and non-tender inguinal hernia on his left side. An initial workup included an abdominal ultrasound, an intravenous pyelogram and cystoscopy, which showed left hydronephrosis and a bulging on the left-side of his bladder wall. On further evaluation, computed tomography confirmed that his sigmoid colon was the source of the pressure effect on his bladder, resulting in hydroureteronephrosis and hematuria. No tumoral lesion was evident. Herniorrhaphy led to the resolution of his signs and symptoms.

Conclusion: Our case illustrates a rare presentation of inguinal hernia responsible for gross hematuria and unilateral hydronephrosis. Urologic signs and symptoms can be caused by the content of inguinal hernias. They can also present as complications of inguinal hernias.

No MeSH data available.


Related in: MedlinePlus

Preoperative abdominopelvic computed tomography scan. Left hydroureteronephrosis (thin arrow). Distal ureteral obstruction and bladder displaced by entrapped herniated sigmoid colon (thick arrow).
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Figure 2: Preoperative abdominopelvic computed tomography scan. Left hydroureteronephrosis (thin arrow). Distal ureteral obstruction and bladder displaced by entrapped herniated sigmoid colon (thick arrow).

Mentions: Genitourinary ultrasonography reported a grade 2 hydroureteronephrosis on his left side. An intravenous pyelogram also revealed left hydroureteronephrosis associated with an ill-defined filling defect on the left side of his urinary bladder (Figure 1). In order to rule out any intravesical lesion, a cystoscopy was performed that showed a bulging on the left side of his bladder wall due to extravesical pressure. The mucosal lining of his bladder was normal. Intravenous and oral contrast-enhanced abdominal computed tomography (spiral multislice thin section scan) showed an entrapped sigmoid colon that was herniated through his left inguinal canal. Anteromedial displacement of his bladder and left ureter were also evident due to the pressure of his sigmoid colon. His left ureter was dilated due to distal obstruction (Figure 2).


Gross hematuria as the presentation of an inguinoscrotal hernia: a case report.

Ansari K, Keramati MR, Rezaei Kalantari K, Jafari M, Godazandeh G, Pakzad M - J Med Case Rep (2011)

Preoperative abdominopelvic computed tomography scan. Left hydroureteronephrosis (thin arrow). Distal ureteral obstruction and bladder displaced by entrapped herniated sigmoid colon (thick arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3275640&req=5

Figure 2: Preoperative abdominopelvic computed tomography scan. Left hydroureteronephrosis (thin arrow). Distal ureteral obstruction and bladder displaced by entrapped herniated sigmoid colon (thick arrow).
Mentions: Genitourinary ultrasonography reported a grade 2 hydroureteronephrosis on his left side. An intravenous pyelogram also revealed left hydroureteronephrosis associated with an ill-defined filling defect on the left side of his urinary bladder (Figure 1). In order to rule out any intravesical lesion, a cystoscopy was performed that showed a bulging on the left side of his bladder wall due to extravesical pressure. The mucosal lining of his bladder was normal. Intravenous and oral contrast-enhanced abdominal computed tomography (spiral multislice thin section scan) showed an entrapped sigmoid colon that was herniated through his left inguinal canal. Anteromedial displacement of his bladder and left ureter were also evident due to the pressure of his sigmoid colon. His left ureter was dilated due to distal obstruction (Figure 2).

Bottom Line: On further evaluation, computed tomography confirmed that his sigmoid colon was the source of the pressure effect on his bladder, resulting in hydroureteronephrosis and hematuria.No tumoral lesion was evident.Herniorrhaphy led to the resolution of his signs and symptoms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Firoozgar Hospital, Tehran University of Medical Sciences, Tehran, Iran. kayvanansari@yahoo.com.

ABSTRACT

Introduction: Several complications have been reported with inguinal hernias. Although hematuria and flank pain, either as the presentation or as a complication of inguinal hernia, are infrequent, this condition may lead to the development of obstructive uropathy, which can have diverse manifestations.

Case presentation: A 71-year-old Iranian man with Persian ethnicity presented with new onset episodes of gross hematuria and left-sided flank pain. A physical examination revealed a large and non-tender inguinal hernia on his left side. An initial workup included an abdominal ultrasound, an intravenous pyelogram and cystoscopy, which showed left hydronephrosis and a bulging on the left-side of his bladder wall. On further evaluation, computed tomography confirmed that his sigmoid colon was the source of the pressure effect on his bladder, resulting in hydroureteronephrosis and hematuria. No tumoral lesion was evident. Herniorrhaphy led to the resolution of his signs and symptoms.

Conclusion: Our case illustrates a rare presentation of inguinal hernia responsible for gross hematuria and unilateral hydronephrosis. Urologic signs and symptoms can be caused by the content of inguinal hernias. They can also present as complications of inguinal hernias.

No MeSH data available.


Related in: MedlinePlus