Skip to main content

Advertisement

SpringerLink
Log in

Accidental bladder injury during elective inguinal hernia repair: a preventable complication with high morbidity

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Introduction

Bladder injury (BI) represents a rare complication of inguinal hernia surgery. Protrusions of the urinary bladder through the deep inguinal ring (“bladder ears”) have been reported with an incidence of 9% in infants younger than 6 months of age and may be misinterpreted as the hernia sac. This literature review was designed to determine incidence and outcomes of bladder injuries during pediatric inguinal hernia repair.

Methods

A literature review of the literature (1967–2017) was performed using the keywords “bladder ears”, “inguinal hernia”, “iatrogenic bladder injury” and “bladder hernia”. Publications were reviewed for epidemiology, presentation and extent of injury, treatment and outcome.

Results

Thirteen articles reporting on 30 cases of BI during inguinal hernia repair from 1967 to 2017 were included (19 boys, 2 girls, 9 unknown). Median age at herniotomy was 10.5 months (1 month–6 years). Out of 30 children, 14 (47%) experienced mild complications. Sixteen patients (53%) had severe complications after initial surgery and needed revisional surgery. Complications were noticed up to 4 years after the initial surgery. In 9 (56%) of the 16 severe cases, major damage to the bladder wall and impairment of bladder capacity occurred. In seven patients (44%), secondary closure was successful. In ten patients (63%), the bladder was partially resected, and in one child (6%), the entire bladder was removed.

Conclusions

The degree of accidental BI during inguinal hernia repair was severe in in the majority of reported cases in the literature. Surgeons should be aware of the high prevalence of “bladder ears” in infants to prevent injury to the urinary tract.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Miyano G, Yamataka A, Okada Y, Shimotakahara A, Kaneko K, Lane GJ, Yamashiro Y, Miyano T (2004) Sigmoidocolocystoplasty for augmentation of iatrogenic small capacity bladder caused by direct injury to the bladder during inguinal hernia repair: long-term follow-up. Pediatr Surg Int 20(1):61–64

    Article  Google Scholar 

  2. Shaw A, Santulli TV (1967) Management of sliding hernias of the urinary bladder in infants. Surg Gynecol Obstetr 124(6):1314–1316

    CAS  Google Scholar 

  3. Allen RP, Condon VR (1961) Transitory extraperitoneal hernia of the bladder in infants (bladder ears). Radiology 77:979–983

    Article  CAS  Google Scholar 

  4. Chang SJ, Chen JY, Hsu CK, Chuang FC, Yang SS (2016) The incidence of inguinal hernia and associated risk factors of incarceration in pediatric inguinal hernia: a nation-wide longitudinal population-based study. Hernia 20(4):559–563

    Article  Google Scholar 

  5. Trobs RB, Yilmaz B, Roll C, Alrefai M (2017) Direct bladder hernia after indirect hernia repair in extremely low birth weight babies: two case reports and a review of the literature. J Med Case Rep 11(1):15

    Article  CAS  Google Scholar 

  6. Redman JF, Ick KA (2001) Abdominoscrotal hydrocele mimicking a herniation of the bladder. South Med J 94(2):235–236

    Article  CAS  Google Scholar 

  7. Colodny AH (1974) Bladder injury during herniorrhaphy. Manifested by ascites and azotemia. Urology 3(1):89–90

    Article  CAS  Google Scholar 

  8. Flach A (1983) Fehler und Gefahren bei der chirurgischen Behandlung des Leistenbruches. Langenbecks Arch Chiv 361:343–346

    Article  Google Scholar 

  9. Tiryaki T, Baskin D, Bulut M (1998) Operative complications of hernia repair in childhood. Pediatr Surg Int 13(2–3):160–161

    Article  CAS  Google Scholar 

  10. Aloi IP, Lais A, Caione P (2010) Bladder injuries following inguinal canal surgery in infants. Pediatr Surg Int 26(12):1207–1210

    Article  Google Scholar 

  11. Redman JF, Jacks DW, O'Donnell PD (1985) Cystectomy: a catastrophic complication of herniorrhaphy. J Urol 133(1):97–98

    Article  CAS  Google Scholar 

  12. Koot VC, de Jong JR, van der Zee DC, Dik P (1998) Subtotal cystectomy as a complication of infant hernia repair. Eur J Surg 164(11):873–874

  13. Chung HM, Yu TJ (1999) Bladder rupture after inguinal herniotomy. Pediatr Surg Int 15(8):584–585

    Article  CAS  Google Scholar 

  14. Imamoglu M, Cay A, Sarihan H, Ahmetoglu A, Ozdemir O (2004) Paravesical abscess as an unusual late complication of inguinal hernia repair in children. J Urol 171(3):1268–1270

    Article  Google Scholar 

  15. Zajaczkowski T (2007) Scrotal bladder hernia: report of two cases. Int Urol Nephrol 39(2):479–484

    Article  Google Scholar 

  16. Wright N (2010) Baby's bladder removed by mistake. J Perioper Pract 20(6):194

    PubMed  Google Scholar 

  17. Bakal U, Sarac M, Tartar T, Ersoz F, Kazez A (2015) Bladder perforations in children. Nigerian J Clin Pract 18(4):483–488

    Article  CAS  Google Scholar 

Download references

Funding

Not Applicable.

Author information

Author notes

  1. Johannes W. Duess and Marie-Catherine Schaller contributed equally.

Authors and Affiliations

  1. Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany

    Johannes W. Duess, Marie-Catherine Schaller, Martin Lacher & Jan-Hendrik Gosemann

  2. Department of Pediatric Radiology, University of Leipzig, Leipzig, Germany

    Ina Sorge

  3. National Children’s Research Centre, Our Lady’s Children’s Hospital, Dublin, Ireland

    Johannes W. Duess, Prem Puri & Jan-Hendrik Gosemann

  4. School of Medicine and Medical Science and Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland

    Johannes W. Duess & Prem Puri

Authors
  1. Johannes W. Duess
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marie-Catherine Schaller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Lacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ina Sorge
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Prem Puri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jan-Hendrik Gosemann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jan-Hendrik Gosemann.

Ethics declarations

Conflict of interest

The author(s) declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duess, J.W., Schaller, MC., Lacher, M. et al. Accidental bladder injury during elective inguinal hernia repair: a preventable complication with high morbidity. Pediatr Surg Int 36, 235–239 (2020). https://doi.org/10.1007/s00383-019-04554-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-019-04554-6

Keywords

Search

Navigation