Percutaneous Reduction of Ureterosciatic Hernia

Weintraub, Jennifer; Pappas, Georgios M; Romano, William; Kirsch, M.; Spencer, W. G.

doi:10.2214/ajr.175.1.1750181

Cited by 27 publications

(22 citation statements)

References 7 publications

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“…It is described in both adults and children. In adults, females are more commonly affected [1,4]. Small bowel, omentum, ureter, ovary, fallopian tube, colon, bladder or Meckel's diverticulum may form the contents of the herniated sac [2,5,6].…”

Section: Discussionmentioning

confidence: 99%

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Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve

Chitranjan

Kandpal²,

Madhusudhan³

2010

BJR

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ABSTRACT. Sciatic hernia is a rare condition with diverse clinical manifestations. We report a case of sciatic hernia causing sciatica, in which the diagnosis made on CT was subsequently confirmed on MRI including magnetic resonance neurography. The salient clinical and imaging features and a brief review are presented. Sciatic hernia is a rare condition that can lead to bowel obstruction, sciatica, pelvic pain, back pain or ureteric obstruction [1,2]. Clinical diagnosis of this condition is difficult. Ultrasonography and CT are the imaging modalities commonly used to diagnose sciatic hernia, although MRI can be used in cases in which entrapment of the sciatic nerve is suspected. Magnetic resonance neurography (MRN) provides high-resolution images to demonstrate entrapment of the nerve and morphological changes in the nerve [3]. Colour Doppler can be useful in surgical planning, as it can provide information regarding bowel viability. Case reportA 55-year-old woman presented with swelling in the left gluteal region and pain in the left lower limb of two years' duration. A detailed clinical history also revealed that she had an abscess in the left gluteal region following an intramuscular injection one year previously; however, at presentation there was no clinical feature suggestive of abscess. Physical examination revealed non-tender soft swelling in the left lumbar region with associated atrophy of gluteal muscles. To diagnose the nature of the gluteal mass, a CT scan of the pelvis and gluteal region was performed. The CT scan revealed herniation of the sigmoid colon through the greater sciatic foramen reaching up to the skin surface and atrophy of the gluteal muscles. Other major pelvic organs including the uterus, ureter and urinary bladder were normally located ( Figure 1). As there was atrophy of the left gluteal muscles, and because the patient had symptoms of sciatica, entrapment of the sciatic nerve by sciatic hernia was suspected. MRI of the pelvis and upper thigh with MRN was performed to confirm entrapment of the sciatic nerve. MRN was used for high-resolution imaging of the sciatic nerve and was performed on a 1.5 T scanner (Sonata, Siemens, Erlangen, Germany) using a pelvis phase-array coil. Sequence parameters included 4 mm section thickness, 0 mm intersection gap, 18-24 cm field of view, 256 6 256 matrix, and an 8-to 10 min imaging time per sequence. The patient underwent axial T 1 weighted spin echo (580/11/2-3 [TR/TE/excitations]) and axial and oblique coronal short tau inversion recovery (STIR, 5000/27/2-3; inversion time, 130 ms) sequences. Coronal oblique images were taken parallel to the course of the sciatic nerve. MRI revealed thickening and increased signal in the left sciatic nerve on STIR coronal oblique images (Figure 2). Lateral deviation and entrapment of the nerve by hernia was also noted along with atrophy of the left gluteal muscles.

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Section: Discussionmentioning

confidence: 99%

“…The salient clinical and imaging features and a brief review are presented. Sciatic hernia is a rare condition that can lead to bowel obstruction, sciatica, pelvic pain, back pain or ureteric obstruction [1,2]. Clinical diagnosis of this condition is difficult.…”

mentioning

confidence: 99%

Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve

Chitranjan

Kandpal²,

Madhusudhan³

2010

BJR

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“…Most cases of sciatic hernia in adults are in women (77%), of whom more than one-third are older than 60 years. 1,3,4 Sciatic hernia is postulated to develop more often in older women because of their relatively large pelvis and sciatic foramen, and possibly because of sagging pelvic muscles caused by multiple pregnancies. The reported sac contents in descending order of frequency are ovary, ureter, small intestine, colon, neoplasm, omentum, and urinary bladder.…”

Section: Discussionmentioning

confidence: 99%

Sciatic hernia with incarcerated urinary bladder: Laparoscopic transabdominal extraperitoneal repair with a mesh plug

Chen

2015

Formosan Journal of Surgery

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An 87-year-old man experiencing abrupt and severe lower abdominal pain was found to have a pulsatile right hip mass. An abdominal computed tomography scan demonstrated that a portion of the redundant urinary bladder was herniating through the right sciatic foramen and into the right gluteus maximus muscle. Laparoscopic transabdominal extraperitoneal repair with a synthetic mesh plug was performed. The patient recovered uneventfully, without recurrence during 3 years of follow-up. The pathogenesis, clinical manifestation, imaging studies, and treatment of sciatic hernia were reviewed.

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“…Most ureteral herniations occur in the inguinal area but they have also been noted in femoral, sciatic, thoracic, and parailiac locations. Among them, ureterosciatic herniation is extremely uncommon; only 31 cases have been reported since 1947 [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Endourological Techniques may Provide a Novel Method for Relieving Urinary Obstruction due to Ureterosciatic Herniation

Kato

Komiya

Ikeda

et al. 2014

Case Rep Nephrol Dial

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Ureterosciatic herniation, the protrusion of the hernia sac through the sciatic foramen, is an extremely rare cause of ureteral obstruction. We describe a case revealed by severe left back pain in a 72-year-old female. She was referred to our hospital for urological assessment of left hydronephrosis observed by ultrasonography. Intravenous ureterography (IVU) showed findings compatible with a left sciatic ureter, a dilated ureter with a fixed kinking, which is known as the ‘curlicue' sign. We decided to attempt recovery of the herniated ureter using a retrograde approach. Ureteral stent placement was performed to decompress the dilated upper urinary tract. The ureterosciatic hernia was relieved with the passage of a flexible guide wire and a double-pigtail stent. Three months after ureteral stenting, she refused continuing to have an indwelling stent and the stent was removed. Thereafter, IVU revealed recurrent ureterosciatic hernia; however, there was no hydroureter or hydronephrosis. The patient is currently being under observation for 6 years after stenting and continues to be without hydronephrosis or symptoms. Placement of an internal stent possibly provides the rigidity to the ureter, thereby reducing the hernia and urinary obstruction. In the previous reports, most symptomatic patients have been treated surgically, with conservative therapy reserved for asymptomatic patients. For the patient who is elderly or a poor surgical candidate, retrograde stenting may provide safe reduction and efficacious treatment. This endourological approach provides a minimally invasive means for the management of urinary obstruction caused by ureterosciatic herniation.

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Percutaneous Reduction of Ureterosciatic Hernia

Cited by 27 publications

References 7 publications

Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve

Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve

Sciatic hernia with incarcerated urinary bladder: Laparoscopic transabdominal extraperitoneal repair with a mesh plug

Minimally Invasive Endourological Techniques may Provide a Novel Method for Relieving Urinary Obstruction due to Ureterosciatic Herniation

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