Hernia Causing Ureteral Obstruction With Hydronephrosis and Subsequent Urinary Tract Infection and Sepsis

Abstract

Inguinal hernias are common anatomic defects, especially among men. Complications of inguinal hernias include incarceration, but incarcerated hernias rarely cause other disturbances. An 86-year-old man with a history of chronic kidney disease (stage IIIb) presented with recurrent urinary tract infections and acute kidney injury with sepsis. Physical examination revealed a right inguinal hernia, and non-contrast abdominal computed tomography revealed right ureteral obstruction and distal entrapment by the inguinal hernia, with hydronephrosis. The patient underwent right retrograde pyelography and ureteral stent placement, followed by laparoscopic inguinal herniorrhaphy with mesh, which restored renal function. Our case is unique among obstructive uropathies due to inguinal hernias because the distal ureter was entrapped within the bowel mesentery communicating between the peritoneal cavity and retroperitoneum. Both inguinal hernias and obstructive uropathy are common among elderly men. While the latter is often secondary to prostate malfunction, other causes of obstructive uropathy or hydronephrosis should be considered, especially if unilateral.

Haematological Profile in Pre-Surgery Hernia Patients: A Case-Control Study in Ghana

“…Our study also revealed a significantly increased burden of inguinal hernia among the cases, which is consistent with existing literature that suggests inguinal hernia is the predominant type of abdominal wall hernia [20]. The increased occurrence of inguinal hernia is ascribed to the altered architecture of the abdominal wall in humans, which may have resulted from evolutionary changes [21].…”

“…The RDW provides information on erythrocyte anisocytosis, and its elevation suggests an impaired synthesis of erythrocytes, which may be observed in haemoglobinopathies and some nutritional deficiencies (like iron-, cobalamin-, or folate deficiency), increased haemolysis, or following haemotransfusion [28]. Also, the variation in the size of erythrocytes could be due to pro-inflammatory cytokines that impede the maturation of erythrocytes by erythropoietin [8,20]. The suggested anisocytosis, therefore, may have resulted from the inflammation-mediated discharge of the immature erythrocytes into circulation [14].…”

Ureteroinguinal herniation complicated by obstructive uropathy and pyelonephritis

“…We report an unusual case of a pre-existing inguinal ureteric hernia that developed obstruction and superimposed pyelonephritis. We have identified just 2 cases in the literature of urosepsis secondary to native ureteroinguinal hernia-related obstruction [11 , 14] .…”

Life-threatening urosepsis because of ureteral entrapment within a large inguinal hernia

“…Common complications of a hernia requiring surgery include incarceration, bowel obstruction, and strangulation [ 1 ]. However, an inguinal hernia containing a ureter is an uncommon clinical entity and usually is asymptomatic [ 2 ]. Ureteral hernias were first reported in the nineteenth century, but since then only about 150 cases have been reported in the literature [ 3 ].…”

“…When the ureter is entrapped, manifestations can include flank pain, recurrent urinary tract infections, or chronic renal damage because of ureteral obstruction. In cases of prolonged entrapment, hydronephrosis and even sepsis may occur [ 2 ].…”