Ureteral Diaphragmatic Hernia Treated with Ureteral Stenting: A Case Report and Review of the Literature.

Tateki Yoshino,Shota Oshima,Koji Kodama,Tomoyuki Sugitani,Shinnosuke Fujikawa,Ayako Itakura,Kazuo Kawakami,Emi Ishibashi,David Duchene

doi:10.1155/2022/4866502

Abstract

Ureteral diaphragmatic hernia through diaphragmatic defects is an exceptionally rare subset of ureteral hernia with only fourteen such cases reported in English manuscripts. An 85-year-old woman was introduced to our department with right flank pain, fever elevation, and nausea. Urinalysis showed bacteriuria, and Escherichia coli was detected in the urine culture. Blood analysis revealed abnormal findings, including elevated WBC count (10,510/μl) and C-reactive protein (0.28 mg/dl). Computed tomography (CT) of the abdomen demonstrated a defect of the right diaphragmatic crus containing a dilated right ureter with associated hydronephrosis. Retrograde pyelography showed hydronephrosis and dilated ureter loops through the defect of diaphragmatic crus, known as a “curlicue sign,” and the diagnosis was right ureteral diaphragmatic hernia. A ureteral stent was placed on her right side, and the ureter was reducted into the retroperitoneal space. After six months, the ureteral stent was removed, with no subsequent recurrence of the ureteral diaphragmatic hernia at seven months. We reviewed all cases in the literature published in English of ureteral diaphragmatic hernia. While the etiology of ureteral diaphragmatic hernia is unknown, our present case and previous reports suggest that a ureteral diaphragmatic hernia may occur due to hepatic atrophy and/or an elevated position of the right kidney.

Highlights

Ureteral hernias are a rare occurrence normally identified incidentally on imaging or during surgical hernia correction and can be a cause of ureteral obstruction [1]
We present a case of right ureteral diaphragmatic hernia containing an incarcerated right proximal ureter with subsequent obstructive pyelonephritis
We review all cases of ureteral diaphragmatic hernia published in the literature in English and discuss optimal treatment methods and the etiology

Summary

Introduction

Ureteral hernias are a rare occurrence normally identified incidentally on imaging or during surgical hernia correction and can be a cause of ureteral obstruction [1]. These hernias can occur in several locations including the inguinal, femoral, obturator, sciatic, and thoracic regions [2]. The rarest location of a ureteral hernia is through a defect in the diaphragmatic muscle [3] with fourteen such cases reported since 1958 in the English language literature [4, 5]. We present a case of right ureteral diaphragmatic hernia containing an incarcerated right proximal ureter with subsequent obstructive pyelonephritis. We review all cases of ureteral diaphragmatic hernia published in the literature in English and discuss optimal treatment methods and the etiology

Case Report

Discussion

Hatzidakis 2014

Findings

Conclusions

Conflicts of Interest