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 .