Ureteroinguinal Hernia: A Rare General Surgery Phenomenon.

Alexandria Turner,Pradeep Subramanian

doi:10.7759/cureus.20586

Abstract

An inguinal hernia involving the ureter is extremely rare and even rarer in patients with native kidneys. It can occur with or without obstructive uropathy and as such, a high index of suspicion should be held for patients with urinary symptoms and concurrent inguinal hernia. Additionally, iatrogenic ureter injury can occur if surgeons are unaware of ureteral involvement pre-operatively. We present a case of a patient with a known ureteroinguinal hernia who proceeded to have an elective hernia repair with ureteral protection.

Highlights

Ureteroinguinal hernias are an extremely rare phenomenon with less than 140 cases documented since 1880; most cases are identified intraoperatively [1,2,3,4,5,6,7]
We report on a symptomatic, native kidney patient who was diagnosed with a ureteroinguinal hernia preoperatively
A 76-year-old man was referred to the General Surgery clinic by our Urology colleagues with a left indirect ureteroinguinal hernia

Summary

Introduction

Ureteroinguinal hernias are an extremely rare phenomenon with less than 140 cases documented since 1880; most cases are identified intraoperatively [1,2,3,4,5,6,7]. Past medical history was significant for renal colic, atrial fibrillation, ischemic heart disease, permanent pacemaker, Ivor-Lewis oesophagectomy for Barrett’s oesophagus with high-grade dysplasia, open right inguinal hernia repair and open umbilical hernia repair He was initially seen by our urology colleagues five months earlier, after being referred by his GP with LUTS. Ureter and bladder (USS KUB) showed a 48cc prostate with slight prominence of the left renal pelvis with no obstructing cause identified. On review two months later, he reported a few episodes of painless macroscopic haematuria and had a computed tomography intravenous pyelography (CT IVP) to exclude renal stone This CT revealed that the distal aspect of the left ureter extended into the left inguinal canal within a left indirect inguinal hernia. The patient remained an inpatient for three days and had an uneventful recovery with nil further recurrence of hernia at the six-month postoperative review

Discussion

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Disclosures