A Case of Obturator Hernia Involving the Urinary Bladder Discovered Following a Femoral Incarcerated Hernia

TL;DR

A rare case of a bladder hernia through the obturator foramen was discovered during a femoral hernia repair in an elderly woman.

Contribution

This case report highlights the rarity and diagnostic challenges of bladder herniation through the obturator foramen.

Findings

Bladder herniation through the obturator foramen is extremely rare and often asymptomatic.

Preoperative imaging is crucial to prevent intraoperative bladder injury during hernia repair.

Laparoscopic TAPP repair successfully managed the hernia with no recurrence observed.

Abstract

Obturator hernias are rare, accounting for 0.05%–1.4% of all hernias, and typically affect elderly, thin women. Bladder hernias, though uncommon, comprise 1%–4% of groin hernias, with bladder herniation through the obturator foramen being extremely rare. We report a case of an obturator hernia involving the urinary bladder, which was incidentally discovered during femoral hernia repair.

A 70-year-old woman presented with a 2-day history of abdominal pain and vomiting. She had no urinary symptoms. Abdominal computed tomography (CT) revealed a right femoral hernia and an unexpected bladder herniation through the obturator foramen. Laparoscopic transabdominal preperitoneal (TAPP) repair was performed using 3 ports. The incarcerated bowel was reduced after incising the lacunar ligament. The prolapsed bladder was carefully dissected to prevent injury, and a dual-layered Bard mesh (Medicon, Franklin Lakes, NJ, USA) was placed to reinforce the defect. The patient recovered uneventfully and was discharged on the 7th postoperative day. No recurrence or urinary symptoms were observed several months postoperatively.

Bladder herniation through the obturator foramen is extremely rare and often asymptomatic, making preoperative diagnosis challenging. Surgeons should consider this condition during hernia repair to prevent intraoperative bladder injury. Preoperative imaging is crucial for safe and complete surgical management.

Figures