A Rare Case of an Irreducible Inguinoscrotal Hernia (Scrotal Cystocele) With a Left Vaginal Hydrocele: A Case Report

Inguinal bladder hernia, also known as scrotal cystocele, first described by Dr. Levine, is considered among the rare cases that may or may not present as scrotal swelling depending on the size of the herniated part. In this particular patient, he presented with scrotal swelling and symptoms related to difficulties in micturition, such as incomplete voiding and increased frequency of voiding urine. On contrast-enhanced computed tomography (CECT), it was revealed that the bladder had been herniated into the inguinoscrotal region, accompanied by a left vaginal hydrocele. The hydrocele was then drained, and the left scrotal sac was everted. The hernial contents were reduced, and an open mesh repair was done to reduce the incidences of recurrence. These cases can generally be seen in obese male patients who are more than 50 years of age and males above 50 years with associated comorbidities. The diagnosis plays a very crucial role in these cases; if the presence of the bladder is not diagnosed preoperatively, then there is a fair chance that the bladder can undergo iatrogenic trauma during surgery. Hence, the clinician should be aware and should consider this situation if the patient comes under the criteria of being above 50 years old, with obesity and/or comorbidities, and with/without symptoms. Although rare, the condition can be treated by undergoing an open surgical repair, wherein the hernial contents are reduced and mesh is put in to avoid reoccurrence.