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we present a case of a papillary urothelial bladder carcinoma in a direct inguinal hernia .
a 79-year - old man presented to our department with a swelling in the left groin evolving over 10 years without any symptoms .
the patient was operated using the transurethral resection of bladder tumor ( tur - bt ) technique 3 months before due to papillary urothelial carcinoma of the prostatic part of the urethra .
the ultrasound examination was inconclusive showing only a left inguinal hernia while the intravenous pyelography revealed an abnormal position of the urinary bladder .
1 ) showed a left groin hernia with an irregular mass content which grows from the urinary bladder ( probably tumor of the bladder wall ) .
the patient underwent open surgery via an inguinal approach ; the tumor was palpated in the herniated portion of the bladder ( fig .
a partial cystectomy was done and the inguinal hernia was repaired without the use of mesh .
pathologic examination of the specimen reported a tumor of 8  cm    5  cm    5  cm ( fig .
4 ) revealed a high - grade carcinoma with necrosis and characteristics of a papillary urothelial carcinoma with invasion of 1/3 of the muscularis propria ( t2a ) .
one year after the operation the patient presented no recurrence of the tumor or hernia .
some researchers have estimated the prevalence may be closer to 10% in men . according to the relationship with the peritoneum
, the hernias are classified as follows : ( a ) paraperitoneal , which are common ( 60% ) in which the peritoneum covers the external aspect of the herniated bladder , can be direct or indirect , as it was in our case ; ( b ) extraperitoneal , in which the tumors do not cover the peritoneum and are usually small ; and intraperitoneal , in which the peritoneum covers the entire portion of herniated bladder .
the most common etiologies of bladder hernias are : obesity , weakness of the pelvic wall , bladder outlet obstruction , and decreased tone of the bladder . in our case
the patient had a history of hernia repair 53 years ago , however , whether a history of herniorrhaphy affects the occurrence of bladder hernia is uncertain .
bladder hernias are usually asymptomatic but are often associated with intermittent swelling in the groin and significant lower urinary tract symptoms . in cases of large
hernias the patients typically present with two - stage micturition , involving spontaneous bladder emptying with a second stage manual compression of the hernia .
the differential diagnosis includes : bladder diverticulum , hernia of a mesenteric cyst , hydrocele and spermatic cord cyst
. the radiological diagnosis can be established by cystography , ultrasonography , and intravenous pyelography or computed tomography .
the numbers of cases of hernia which contain a tumor of the urinary bladder being published are low ( table 1 ) .
the purpose of treatment is to remove the tumor , repair the hernia and correct the obstructive condition of any lower urinary tract .
the patient survival is low due to the delay and difficulty in obtaining an accurate diagnosis . despite the overall poor prognosis
inguinal bladder hernias are relatively uncommon , with few ( 22 ) reports of tumor in the herniated bladder have been published in the international literature ( medline / pubmed ) .
the surgical management consists of removing the herniated bladder tissue containing the tumor with a marginal of safety , and repairing the hernia , with careful urological follow up .
written informed consent was obtained from the patient of the publication of this case report and accompanying images .
a copy of the written consent is available for review by the editor - in - chief of this journal of request .
anastasios katsourakis participated in the design of the study and drafted the manuscript ; george noussios participated in the coordination and helped to draft the manuscript ; christos svoronos performed the literature review ; michael alatsakis helped to draft the manuscript ; efthimios chatzitheoklitos participated in the coordination .
introductioninguinal hernia containing bladder carcinoma is a very rare occurrence.presentation of casewe report a case of a male patient who presented with a left groin hernia containing an irregular mass . 
 the hernia was repaired without the use of mesh and a partial cystectomy was done.discussiononly 13% of all inguinal hernias involve the bladder , with very few reports containing a carcinoma.conclusiontreatment consists of removing the tumor and repairing the hernia .