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Thứ Bảy, 30 tháng 6, 2018

NHÂN CA THOÁT VỊ TRƯỢT BÀNG QUANG VÀO BÌU TRÁI

Thoát vị bàng quang vào bìu hiếm gặp. Thường là thoát vị bẹn trượt (sliding inguinal hernia), có nhiều nguyên nhân, nhưng ca 501 Medic chỉ do thành bụng bẹn T yếu, trong khi y văn cho thấy là do biến chứng sau mổ tiền liệt tuyến với vùng bẹn yếu, hay giảm trương lực bàng quang thứ phát do u xơ tiền tuyến hay bế tắc đường tiểu. Triệu chứng điển hình là tiểu 2 lần: lần đầu tiểu ngẩu nhiên bình thường, kế đó ép khối vùng bẹn và đi tiểu tiếp tục.
Chẩn đoán  trước mổ chủ yếu là siêu âm và chụp cản quang bàng quang ngược dòng, với hình bàng quang thoát vị dạng quả tạ [dumbbell shaped urinary bladder];  chẩn đoán đúng gíup tránh làm rách bàng quang khi mổ khâu thoát vị bẹn [herniorhapphy].












J Radiol Case Rep. 2009;3(2):7-9. doi: 10.3941/jrcr.v3i2.91. Epub 2009 Feb 1.

Cystogram with dumbbell shaped urinary bladder in a sliding inguinal hernia.

Abstract

Sliding inguinal hernias present with various symptoms and these are usually direct inguinal hernias containing various abdominal viscera. Case reports and series have been published with various organs and rare organs being part of the hernia. Urinary bladder is a known content of sliding hernias. This case report emphasizes this aspect in a picturesque manner and the importance of radiological investigations for pre-surgical evaluation.

KEYWORDS:

Bladder herniation; Cystogram; Inguinal hernia; Prostatic hypertrophy; Sliding hernia


 [Bladder hernia]. Ann Ital Chir. 1995 May-Jun;66(3):363-9.
 [Article in Italian]
Abstract
A case of bladder hernia in a 61 years old patient affected by benign prostatic hypertrophy is presented. Pre-operative diagnosis was made by cystography. After an adenomiomectomy of the prostate, the patient underwent the resection of the herniated bladder which gave the bladder its normal shape with only a slight reduction of its capacity. Inguino-scrotal bladder hernias are very rare; recognized predisponing factors are weakening of muscular and connective structures of the inguinal canal, and bladder hypotonia secondary to urethro-prostatic obstruction.
These hernias, according to the anatomical position of the hernial sac, bladder and peritoneum, are classified in paraperitoneal (most frequent), intraperitoneal and extraperitoneal. The typical symptom of this disease is the two-stage micturition: the patient after a first spontaneous voiding, presses the mass and voids again. Other than cystography, useful diagnostic means are urography and cystoscopy which may confirm the diagnosis and rule out associated urinary disease.
The treatment consists of either simple reduction of the bladder hernia, if the hernia is small, or resection of the herniated portion of the bladder, if the hernia is large or is associated with other diseases (e.g. tumors). Bladder resection is then followed by closure of the bladder wall in two layers and by inguinal hernia repair.
Actas Urol Esp. 1999 Jan;23(1):79-82.
[A massive hernia of the bladder into the scrotum. A report of a case].
[Article in Spanish]
Abstract
The hernia of the bladder in the scrotum is a highly uncommon observation. From the clinical standpoint the usual manifestation is a two-stroke voiding. The recommended urological examinations to reach a diagnosis are ultrasound, endovenous urography, retrograde urethrocystography and cystoscopy. Management includes the de-obstruction of the lower urinary tract, if present, resection of associated peritoneum, resection or reduction of the vesical hernia and repairment of inguinal path. The case contributed corresponds to a vesical hernia in a 72-year-old patient, with no obstructive cause, that was treated surgically by resection of the herniated bladder, with good morphological and functional results.
 1997 May;21(5):514-8.

[Vesico-scrotal hernia. Report of a clinical case].

[Article in Spanish]

Abstract

Incidental discovery of vesical hernias during herniorrhaphy is quite common. In such cases, patients are usually asymptomatic since the hernia portion is small and easily repairable. On the other hand, vesical solid protrusion to the scrotum is quite unusual, and is generally found associated to obstructive urinary symptoms. Management involves basically the correction of any associated obstructive conditions, correction of the vesical hernia and herniorrhaphy.

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