Obstructive Uropathy Due to an Incarcerated Ureteroinguinal Hernia

Abstract

Ureteroinguinal hernia with or without ureteral incarceration resulting in obstructive uropathy is an especially uncommon case. Ureteroinguinal hernia should be included in the differential diagnosis when a hernia is detected on physical exam or found on imaging concurrent with new or unexplained hydronephrosis. The present case illustrates the importance of recognizing this condition. This patient, with a history of renal transplant, was asymptomatic other than a reducible inguinal hernia on exam and an elevated creatinine on lab work. Nephrostomy tube placement, an important temporizing measure to relieve obstruction, and subsequent ureteral reconstruction with inguinal hernia repair was successful in preserving the patient's transplant kidney function. The management described may be helpful in guiding future surgical approaches to similar scenarios.

Ureteral herniation in kidney transplant - Case Report

“…Most of the patients had over five years of kidney transplant , and almost half of them had over ten years of the procedure [5][6][7]11,13,[15][16][17]20,21,23]. Literature does not provide any statistical evidence for the connection between post-operative time and the identification of ureteric-inguinal hernia.…”

Rare course of the ureter

“…Preoperative imaging such as CT urography has been suggested for patients with urinary symptoms and unilateral hernia 3,5 . CT of the abdomen/pelvis and possibly ureterography should be considered for large inguinoscrotal hernias to minimize iatrogenic ureteric injuries as it allows for prior identification of hernia contents and appropriate operative planning 7,8 …”

“…3,5 CT of the abdomen/pelvis and possibly ureterography should be considered for large inguinoscrotal hernias to minimize iatrogenic ureteric injuries as it allows for prior identification of hernia contents and appropriate operative planning. 7,8 Although the risk of strangulation and ureteric obstruction is relatively low given the large size of the hernia, 9 inadvertent ureteric injury is a serious complication which may be unrecognized at the time of surgery due to unexpected encounter with the ureter in the operative field. Careful inspection of hernia contents and separation of cord structures are crucial to avoid such injuries.…”

Laparoscopic approach to ureteroinguinal hernia

“…Majority of the cases where the preoperative diagnosis was not available have resulted in injury to ureter; most often presenting in the postoperative period. Management ranged from percutaneous nephrostomy to nephrectomy, exploratory laparotomy and resection of the ureter with reimplantation [ 7 ]. Due to delay in recognition of ureteric injury following hernia repair, mortality has been described in paediatric age group [ 8 ].…”

“…Due to delay in recognition of ureteric injury following hernia repair, mortality has been described in paediatric age group [ 8 ]. In cases where a preoperative diagnosis has been made, the management ranged from a simple reduction in open hernia surgery to a complex procedure like ureteroneocystostomy to deal with the redundant ureter [ 7 , 9 ]. Laparoscopy has gained wide acceptance and popularity in the management of hernia and has the benefit of decreased postoperative pain and neuralgic complications.…”