Bladder in the Hole and a Hole in the Bladder: Spigelian Hernia Involving the Urinary Bladder with Mesh Erosion

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Introduction: Bladder involvement within Spigelian hernias is a rare finding, involving herniation of the bladder wall through the Spigelian aponeurosis, often presenting with abdominal pain or urinary tract infections (UTIs). Mesh erosion into the bladder following inguinal hernia repair is also an uncommon but serious complication. We report a unique case involving both conditions in a 72-year-old male presenting with acute urinary retention. Case Description: A 72-year-old male with a history of bladder carcinoma in situ, bladder diverticulum, right inguinal hernia mesh repair, and recurrent UTIs presented with abdominal pain, urinary frequency, and retention. Laboratory data revealed acute kidney injury (AKI) with a creatinine of 4.42 mg/dl. Computerised Tomography (CT) abdomen identified a moderate right-sided Spigelian hernia containing fluid connected to the bladder (Fig 1A). AKI resolved with indwelling bladder catheter placement. A CT cystogram demonstrated contrast extravasation from the bladder into the hernia sac, raising concern for leak or diverticulum within the hernia (Fig 1 B-C). Cystoscopy confirmed a bladder diverticulum within the Spigelian hernia with intravesical mesh erosion. The patient was managed with chronic catheterization and planned cystectomy with normalization of renal function. Discussion: We present a rare complication of inguinal hernia repair leading to mesh erosion of a bladder diverticulum within a Spigelian hernia, leading to AKI that has thus far not been reported in the literature. Diagnosis is achieved through CT cystogram or cystoscopy. Definitive management requires surgical intervention, including hernia and diverticulum repair, removal of the eroded mesh, potentially necessitating cystectomy depending on the extent of bladder involvement.

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