Graft kidney hydronephrosis caused by transplant ureter inguinal hernia

Abstract

Rationale: Ureteral obstruction of the graft kidney is a common complication of kidney transplantation. However, ureteral obstruction caused by inguinal hernia has rarely been reported. We present a rare case of ureteral obstruction with allograft dysfunction caused by an inguinal hernia.Patient concerns: A 76-year-old man, who was a renal transplant recipient, presented with bilateral pitting oedema, reduced urine output, and right inguinal hernia.Diagnoses: Abdominal computed tomography revealed severe hydroureteronephrosis of the kidney allograft. A right inguinal hernia with ureteral incarceration was observed. Interventions:The patient underwent graft percutaneous nephrostomy, followed by antegrade insertion of a double-J tube (DJ). Gradual improvement was observed in his renal function. Right inguinal herniorrhaphy was performed 5 days later.Outcomes: The renal function returned to normal after percutaneous nephrostomy and insertion of the DJ. A right inguinal directtype hernia with ureter adhesion to the hernial sac was observed during the surgery. The posterior wall defect was repaired by the McVay technique. The DJ was removed after 1 month. The patient's renal function remained stable at 6-month follow-up.Lessons: The orientation of the graft kidney has a significant influence on the location of the ureter. Upward orientation of the hilum will result in superficial location of the ureter, rendering it close to the hernial sac and susceptible to incarceration. The transplant surgeon should be aware of such a presentation of graft dysfunction with inguinal hernia to prevent a delay in the diagnosis and graft loss.

Ureteroinguinal Hernia: A Case Report

“…Inguinal herniation of the ureter is an uncommon incidence either as a renal transplant complication or spontaneously (1,2). Ureteroinguinal herniation can cause obstructive uropathy (3,4), however, the patient might only be complaining of inguinal pain, such as in our case. We present a suspected left inguinal hernia which was later diagnosed as inguinal herniation of the ureter without any signs of obstruction in the urinary system since the left urinary system possessed dual ureters and the right one was still functional.…”

A Rare Case of Inguinal Hernia of a Ureter Belonging to a Duplex Kidney

“…Nevertheless, inguinal hernia of the ureter is a rare event, occurring either as a complication of renal transplantation or spontaneously [ 4 , 5 ]. Ureteroinguinal hernia may lead to obstructive uropathy [ 6 , 7 ]; however, as in the present case, the patient may have relatively nonspecific symptoms. This case report describes a patient who was initially diagnosed with a left inguinal hernia but was ultimately discovered to have an inguinal hernia of the ureter, with no evidence of obstructive uropathy.…”

Difficulties in Diagnosing Extraperitoneal Ureteroinguinal Hernias: A Review of the Literature and Clinical Experience of a Rare Encounter in Acute Surgical Care Settings

“…Thus, ultrasound findings of renal ectopia with tortuous ureters are predisposed to ureteral herniation [ 55 ]. In transplanted kidneys, the same event can occur where a malpositioned new kidney placed in the lower abdomen [ 56 ] can allow its ureter to be displaced in an inguinal hernia [ 57 , 58 , 59 , 60 , 61 , 62 ]. Statistically, females are much less likely to develop a herniation of the ureter in the inguinal region, where the most common appearance is the ureterocrural hernia [ 19 , 63 , 64 ].…”