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\begin{document}

\title{Bilateral inguinal bladder hernias}



\author[1]{Naoya Fujita}%
\author[1]{Yosuke Ono}%
\author[1]{Yasuhiro Obuchi}%
\author[1]{Yuji Tanaka}%
\affil[1]{National Defense Medical College}%


\vspace{-1em}



  
  \date{March 13, 2025}


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\selectlanguage{english}
\begin{abstract}
Inguinal hernia may contain the bladder as one of its contents, while
bilateral inguinal bladder herniation is rare. Urinary obstruction and
obesity are associated with increased abdominal pressure and are risk
factors of bladder herniation. Clinicians should be aware of the bladder
hernia in elderly with chronic dysuria and obesity.%
\end{abstract}%



\sloppy


\textbf{Titles:} Bilateral inguinal bladder hernias

\textbf{Authors:} Naoya Fujita, M.D., Yosuke Ono, M.D., Ph.D., Yasuhiro
Obuchi, M.D., Ph.D., Yuji Tanaka, M.D., Ph.D.

\textbf{Correspondence to:} Naoya Fujita, Department of General
Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa,
Saitama 359-8513, Japan.

Phone: +81-429-95-1211 (ext: 3633); Fax: +81-429-91-1238

E-mail: \emph{raoh0615@gmail.com}

\textbf{Co-author's full contact information, including e-mail
addresses:}

Yosuke Ono, MD, PhD. Department of General Medicine, National Defense
Medical College, 3-2 Namiki, Tokorozawa, Saitama 3598513, Japan. Tel:
+81-429-95-1211 (Ext.: 3633). Fax: +81-429-91-1238. E-mail:
onoyousuke1979@yahoo.co.jp

Yasuhiro Obuchi, MD, PhD. Department of General Medicine, National
Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 3598513, Japan.
Tel: +81-429-95-1211 (Ext.: 3633). Fax: +81-429-91-1238. E-mail:
ybuchi@ndmc.ac.jp

Yuji Tanaka, MD, PhD. Department of General Medicine, National Defense
Medical College, 3-2 Namiki, Tokorozawa, Saitama 3598513, Japan. Tel:
+81-429-95-1211 (Ext.: 3633). Fax: +81-429-91-1238.
E-mail:\emph{yitanaka@ndmc.ac.jp}



\textbf{Abstract}

Inguinal hernia may contain the bladder as one of its contents, while
bilateral inguinal bladder herniation is rare. Urinary obstruction and
obesity are associated with increased abdominal pressure and are risk
factors of bladder herniation. Clinicians should be aware of the bladder
hernia in elderly with chronic dysuria and obesity.

\textbf{Key words:} bladder hernia, benign prostatic hyperplasia

An 80-year-old male, whose body mass index was 25.9
kg/m\textsuperscript{2}, presented with bilateral groin pain despite no
tenderness or palpable masses in either inguinal region. He had an
8-year history of dysuria due to benign prostatic hyperplasia. Computed
tomography showed bilateral inguinal hernias appearing as fluid-filled
structures continuous with the bladder (Figure 1). The pain was not
relieved by urination. Open surgical hernia repair was therefore
performed.

Inguinal hernia may contain the bladder as one of its
contents\textsuperscript{1)}, while bilateral inguinal bladder
herniation is rare. Horizontal section images of bilateral inguinal
bladder hernias are described as ``Pelvic Mickey Mouse Sign'' because
they resemble the Walt Disney character\textsuperscript{2)}. Chronic
urinary obstruction and obesity are associated with increased abdominal
pressure and are risk factors of bladder herniation. Clinicians should
be aware of the inguinal bladder hernia as a cause of groin pain in
middle-aged and older male with chronic dysuria and obesity.

\textbf{Acknowledgements:} None.

\textbf{Conflict of interest:} None.

\textbf{Author contributions:} Naoya Fujita wrote the first draft.
Yosuke Ono and Yasuhiro Obuchi suggested improvements. Yuji Tanaka
revised the manuscript and suggested final changes.

\textbf{Consent:} Written informed consent was obtained from the patient
to publish this report in accordance with the journal's patient consent
policy.

\textbf{References}

Sagar A, Sabharwal S, Kekre NS. Bilateral vesical inguinal hernia: A
perineal 'Mickey mouse'. \emph{Indian J Urol.} 2013;29(2):154-155.

Branchu B, Renard Y, Larre S, Leon P. Diagnosis and treatment of
inguinal hernia of the bladder: a systematic review of the past 10
years. \emph{Turk J Urol.} 2018;44(5):384-388.

\textbf{Figure Legend}

\textbf{Figure 1:} Contrast-enhanced computed tomography of the abdomen.
Bilateral bladder hernias are shown as fluid-filled structures
continuous with the bladder.\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/Fujita-Figure/Fujita-Figure}

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