Ureteroinguinal Herniation with Consecutive Ureteral Stricture in a 2-Month-Old Infant: Case Report

Abstract

Inguinal herniation of ureter is an uncommon finding among children, with scarce reported cases in the literature to date, that can potentially lead to obstructive uropathy. We report a case of ureteroinguinal herniation discovered during an inguinal hernia repair in a patient with antenatally ultrasound finding of hydronephrosis. A 2-month-old infant with antenatal left hydronephrosis presented with left inguinal mass. Preoperative ultrasound showed an anechoic tubular image producing a mass effect on the left testicle, with suspected bladder herniation and/or dilated ureter toward the inguinal canal. An open surgical inguinal exploration was performed, where the left inguinal canal revealed a peritoneal sac and sliding of the dilated left ureter behind the sac, with a significant change in diameter, corresponding to the paraperitoneal variant of ureteroinguinal herniation. Ligation of the sac and replacement of the ureter into the retroperitoneum were performed, with improvement in the hydronephrosis observed on the ultrasound 1 month after the intervention. However, 6 months later, hydronephrosis worsening as well as the obstructive pattern observed in the diuretic renogram required removal of the stenotic ureteral segment and reimplantation of the healthy proximal segment in the bladder by open approach (Cohen's reimplantation). Follow-up ultrasound of the renal tract showed no dilatation of the upper renal tract and the renal function tests were normal. Currently, the patient is 2 years old and he remains asymptomatic. In conclusion, signs of ureteral obstruction such as hydronephrosis in patients with inguinal herniation may suggest the possibility of an ureteroinguinal hernia. Preoperative diagnostic suspicion is essential.

Keywords

ureteroinguinal hernia - herniation of the ureter - hydronephrosis - upper urinary tract obstruction

Note

Ureteroinguinal hernia is an uncommon finding among children that can potentially lead to obstructive uropathy patients. The concomitant association of inguinal hernia and ipsilateral hydronephrosis should lead us to suspect this type of hernia. Preoperative suspicion is essential to avoid possible iatrogenic lesions in the ureter.

Publication History

Received: 18 May 2023

Accepted: 21 October 2023

Article published online:
22 January 2024

• References

• 1 Bosschieter J, van Roij K, Ahmadi N, Bokenkamp A, van der Horst HJR. Kidney blow out due to inguinal herniation of the ureter in an infant. Urol Int 2018; 100 (04) 488-490
• 2 Smith MT, Wong NC, Coleman JA. Inguinal hernia of the distal ureter causing hydronephrosis: a rare case. Urol Case Rep 2020; 35: 101549
• 3 Hosoda T, Hijikata K, Ishioka S. Rare case of inguinal ureteral hernia in a child diagnosed by drip infusion pyelography-computed tomography. Int J Surg Case Rep 2022; 94: 107007
• 4 Handu AT, Garge S, Peters NJ, Kanojia RP, Rao KL. Undiagnosed ureteroinguinal hernia with solitary kidney in a child with ureteric injury during herniotomy. J Pediatr Surg 2012; 47 (04) 799-802
• 5 Morris LL, Caldicott WJ, Savage JP. Inguinal herniation of the ureter. Pediatr Radiol 1977; 6 (02) 107-108
• 6 Powell MC, Kapila L. Bilateral megaureters presenting as an inguinal hernia. J Pediatr Surg 1985; 20 (02) 175-176
• 7 Burgu B, Reşorlu B, Süer E, Soygür T. Scrotal hernia of the ureter in association with posterior urethral valves. J Pediatr Urol 2010; 6 (01) 87-88
• 8 Sripathi S, Rajagopal K, Kakkar C, Polnaya A. Case report-inguinoscrotal ureteral hernia diagnosed on micturating cystourethrography. Indian J Radiol Imaging 2011; 21 (03) 199-201
• 9 Cao K, Turner M, Mishrah P, Cuckow P. The rare case of an extraperitoneal ureteral herniation into the inguinal canal of a 12-year-old boy. Ann R Coll Surg Engl 2019; 101 (01) e32-e34
• 10 Wishahi M. Congenital primary obstructed megaureter presenting as inguinal hernia in an infant. Clin Case Rep 2022; 10 (04) e05677
• 11 Cianci MC, Tocchioni F, Mantovani A, Ghionzoli M, Morini F. Unexpected pediatric uretero-inguinal hernia: case-report and literature review. Urology 2023; 176: 178-182
• 12 Verbeeck N, Niedercorn JB, Mc Intyre D, Pouthier D, Lamy S. Assessment of renal graft obstruction due to ureteral inguinal hernia: US detection and 3D MR confirmation. JBR-BTR 2007; 90 (02) 132-134
• 13 Autore G, Bernardi L, Ghidini F. et al; The Uti-Ped-Er Study Group. Antibiotic prophylaxis for the prevention of urinary tract infections in children: guideline and recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) study group. Antibiotics (Basel) 2023; 12 (06) 1040
• 14 Giglio M, Medica M, Germinale F. et al. Scrotal extraperitoneal hernia of the ureter: case report and literature review. Urol Int 2001; 66 (03) 166-168
• 15 Rocklin MS, Apelgren KN, Slomski CA, Kandzari SJ. Scrotal incarceration of the ureter with crossed renal ectopia: case report and literature review. J Urol 1989; 142 (2 Pt 1): 366-368
• 16 Holzman SA, Braga LH, Zee RS. et al. Risk of urinary tract infection in patients with hydroureter: an analysis from the Society of Fetal Urology Prenatal Hydronephrosis Registry. J Pediatr Urol 2021; 17 (06) 775-781