Genitourinary Radiology > Bladder > Outpouching of Bladder Wall > Herniation


Herniation

 

Bladder herniation is an unusual cause of a small or asymmetric bladder. Herniation may occur through a pelvic or abdominal opening, usually the inguinal or femoral canals (95%). Small inguinal herniations, or “bladder ears,” are a normal incidental finding on 9% of voiding cysturethrograms. In most patients, herniation is asymptomatic, but inadvertent perforation may occur during herniorrhaphy. In symptomatic patients, two-stage voiding is classic: first the patient empties the bladder proper, then manually compresses the herniated portion of the bladder.

Most are less than 2-2.5cm in size, but are ocassionally massive. The wall of hernia is smooth, but the hernia sac may be complicated by stone formation or inflammation. Cystography may be better than IVU in showing continuity with the bladder.

Cystogram shows left side of bladder traversing an open left inguinal ring (arrow).
Image from LE. Bacigalupo, et al. Imaging of Urinary Bladder Hernias. Am. J. Roentgenol., Feb 2005; 184: 546 - 551.



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