Inguinoscrotal Bladder Herniation With Mery's Sign: Individualized Timing and Primary Repair in the Setting of Suspected Urinary Infection.

Urinary bladder involvement in inguinal hernias is an uncommon condition, predominantly affecting older men and potentially causing urinary obstruction, infection, and renal dysfunction. We present the case of a 79-year-old man with a six-month history of progressive right inguinoscrotal enlargement, lower urinary tract symptoms, hematuria, and a positive Mery's sign. Laboratory studies revealed renal dysfunction and urinary abnormalities in the setting of suspected urinary tract infection. Computed tomography demonstrated a right inguinoscrotal hernia containing the urinary bladder, with associated bladder wall thickening. Surgical repair was initially deferred to allow clinical optimization and initiation of antimicrobial therapy. Five days later, persistent fever, leukocytosis, worsening urinary findings, flank pain, and persistent systemic inflammatory response despite antimicrobial therapy prompted surgical intervention. The hernia was reduced through a lower midline infraumbilical approach, and primary tissue repair without prosthetic mesh was performed. After antimicrobial escalation, renal function recovered, inflammatory markers decreased, and the patient was discharged without surgical complications. At the two-month follow-up, no hernia recurrence was observed. Bladder-containing inguinoscrotal hernias should be considered in elderly men presenting with inguinal or scrotal masses and lower urinary tract symptoms. Computed tomography is valuable for diagnosis and surgical planning. When urinary infection is suspected or inflammatory findings are present, individualized timing and technique of repair may be appropriate in selected patients according to clinical response and operative findings.