Primary posterior perineal herniation of urinary bladder
A 63-year-old multiparous lady presented with complaints of a bulge in the gluteal region that appeared while coughing. Physical examination revealed a visible bulge in the posterior perineal region that could be reduced to reveal a defect in the perineum with an expansile cough impulse []. Per rectal examination revealed a palpable defect in the pelvic floor muscles. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of pelvis demonstrated a perineal hernia with herniation of a portion of the urinary bladder and rectal wall through pelvic floor [Figures –].\nShe underwent laparoscopic exploration, mesh repair of the hernial defect, and rectopexy. A defect was noticed in the levator ani on the right side, through which the urinary bladder and a portion of rectum was herniated. Herniated contents were dissected free, rectum was fully mobilized up to the pelvic floor, and a defect in the pelvic floor was displayed. A polypropylene mesh was deployed to cover the defect, mesh rectopexy was done using a polypropylene mesh [], and hitching of urinary bladder to the anterior abdominal wall was performed. At the time of writing this article, the patient is symptom free on follow-up of 22 months.