After the nonconclusive findings of the ultrasound examination about the content and the exact relations of the hernia, we performed urgent retrograde cystogram which showed a huge urinary bladder diverticulum herniating find more into the femoral canal, a finding which was confirmed intra operatively. The urinary bladder diverticulum

herniated into the femoral canal was associated with a reducible indirect inguinal hernia. Up to our knowledge, this combination had never been reported in the literature review. The treatment of symptomatic bladder diverticula secondary to benign prostatic hypertrophy, either as a content of a AP24534 hernia or not, is diverticulectomy and simple prostatectomy [13]. The surgical treatment of a bladder diverticulum herniated through the femoral or inguinal canals can be performed either by extra or intra peritoneal approaches. Regarding this case, we approached the femoral hernia posteriorly and extraperitonealy while the coexisted inguinal hernia was approached anteriorly through an extended Pfannenstiel incision. Prostatectomy was not performed respecting the patient wishes as he preferred medical treatment

with alpha-blockers and 5-alpha reductase inhibitors. Conclusion selleckchem Urinary bladder diverticula should be considered as a possible content of femoral hernias especially in males with long standing obstructive lower urinary tract symptoms. As the clinical features of such a case are not specific, a high index of suspicion along with proper imaging studies are of great help in making a timely diagnosis to improve the outcome. Combined femoral hernia containing a bladder diverticulum with an inguinal hernia is a possible entity. Consent Written informed consent was obtained from the patient for publication of this case report and accompanied images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Ethical approval Institution Review

Board (IRB) of the Jordan University of Science Ketotifen and Technology and King Abdallah University Hospital granted the approval for all the work done in these institutions. References 1. Francoise F, Brunner P, Cucchi JM, Mourou MY, Bruneton JN: Inguinal herniation of a bladder diverticulum. Clin Imaging 2006, 30:354–356.CrossRef 2. Dahlstrand U, Woller S, Nordin P, Sandblom G, Gunnarsson U: Emergency femoral hernia repair: a study based on a national register. Ann Surg 2009, 249:672–676.CrossRefPubMed 3. Ihediona U, Alani A, Modak P, Chong P, O’Dwyer PJ: Hernias are the most common cause of strangulation in patients presenting with small bowel obstruction. Hernia 2006, 10:338–340.CrossRef 4. Schuster F, Steinbach F: Scrotal diverticulum of the urinary bladder, a rare cause of inguinal hernia.