As in Real Estate, Location Is What Matters: A Case Report of Transplant Ureteral Obstruction Due to an Inguinal Hernia

Abstract

Background:Kidney allograft dysfunction is common and often reversible but can lead to allograft loss if not promptly evaluated. Transplant ureteral obstruction in an inguinal hernia is a rare cause of allograft dysfunction, but early recognition may prevent allograft loss.Case Presentation:We present a case of a man with acute kidney allograft dysfunction who received a deceased donor kidney transplant 6 years earlier for end-stage kidney disease secondary to polycystic kidney disease. Abdominal ultrasounds revealed hydronephrosis without full visualization of the transplant ureter. Abdominal computed tomography revealed moderate hydronephrosis of the transplant kidney due to obstructed herniation of the transplant ureter in a right inguinal hernia. A stent was inserted into the transplant ureter to prevent further allograft dysfunction and facilitate hernia repair.Conclusions:Transplant ureteral obstruction is a rare cause of acute kidney allograft dysfunction, and its detection can be challenging. The recognition of transplant ureteral obstruction is vital to timely management for preventing allograft loss.

Graft kidney hydronephrosis caused by transplant ureter inguinal hernia

“…In our case, the ureter was located deep in the posterior wall of the inguinal canal and close to the neck of the hernial sac. To our knowledge, this is one of the few studies to have preoperative DJ insertion [17] . Although most of the case reports related to this topic had no DJ insertion prior to surgery, there is no data regarding their operation time and the risk of ureter injury during surgical exploration.…”

“…To our knowledge, this is one of the few studies to have preoperative DJ insertion. [17] Although most of the case reports related to this topic had no DJ insertion prior to surgery, there is no data regarding their operation time and the risk of ureter injury during surgical exploration. We propose that preoperative ureteral stent insertion may be a good option to avoid ureteral injury during herniorrhaphy of the transplant ureter inguinal hernia.…”

Inguinal hernia containing a native orthotopic kidney

“…Paraperitoneal hernias are due to adherence of the ureter to the hernia sac posterior (80% of ureteroinguinal hernias), whereas extraperitoneal hernias do not involve the hernia sac and are due to descent of the ureter into the scrotum with the testicle 4. Ureteroinguinal hernias are also seen with transplant kidneys and are a rare cause of ureteral obstruction and acute kidney allograft dysfunction 3 5–7…”

“…It is estimated that more than 20 million hernias are repaired worldwide and about 500 000 per year in the USA 1. Involvement of a solid abdominal organ in a primary abdominal hernia is a rare event, with documented genitourinary organs including bladder, ureter and renal transplants including the transplant ureter 2 3. Here, we present a case of an incidentally identified right inguinal hernia containing an orthotopic right kidney.…”

Transplant Ureter Inguinal Herniation Treated by Robotic Inguinal Hernia Repair

“…3,4 However, transplant ureteral obstruction caused by inguinal hernia is rare. 1 There are few cases published in the literature, [1][2][3][5][6][7][8][9][10][11][12][13][14][15][16][17] and in almost all reported cases, herniation occurred into the ipsilateral inguinal canal. 10 The robotic surgical approach has been described in cases of complex inguinal hernia repair, such as after prior prostatectomy or in inguinoscrotal hernias.…”