Kidney Dislocation in a Monstrous Inguinal Intestinal Hernia with Ureteropelvic Junction Obstruction and Acute on Chronic Renal Failure

Abstract

Introduction: Inguinal hernias are the most common hernias in adult males. Abnormalities should be taken into account for therapeutic procedures. This is the first report of a dislocation of a primary orthotopic kidney in a monstrous inguinal intestinal hernia. Case Presentation: This paper reports an incidental finding of a dislocation of a primary orthotopic kidney in a monstrous inguinal intestinal hernia of an 82-year-old patient with intracranial injury and acute kidney failure. Post-renal kidney failure could be excluded by ultrasound and CT examination. The acute renal decompensation resulted from rhabdomyolysis associated with a falling down trauma with crush syndrome and pneumonic septicaemia based on chronic renal failure associated with nephrosclerosis and ureteropelvic junction obstruction conditioned atrophic right kidney. Conclusion: Previous reports in the literature include inguinal-scrotal hernias containing ureter and bladder with post-renal failure or containing ectopic congenital pelvic or transplanted iliac kidney. Our patient is very unusual in that he presented with inguinal herniated, orthotopic, atrophic hydronephrosis with suspicion of congenital ureteropelvic junction obstruction as well as an asymptomatic large intestinal hernia. Reasons for pre-renal acute on chronic renal failure can make it difficult to arrive at a decision of a urological therapy.

“Extreme Nephroptosis”: A Kidney in the Inguinal Hernia

“…This is due to the massive size of the hernia, the poor general status, and the age of the patients. All seven men in our study had large or “giant” irreducible hernias, including the monstrous hernia described by Wendler et al [ 3 ]. In addition, all patients had hernias for an extended period.…”

An unusual inguinoscrotal hernia with renal involvement

“…The other report, by Wendler et al ,9 described the dislocation of a primary orthotopic kidney in a large inguinal hernia.…”

Inguinal hernia containing a native orthotopic kidney

“…To date, there are only two documented reports of inguinal hernias containing orthotopic kidneys as opposed to pelvic kidneys. Farrell et al described case of a duplicated kidney within the hernia sac, whereas Wendler et al found a massive inguinal hernia containing multiple loops of bowel as well as the right kidney 12 13. Both of these kidneys had vasculature that could be traced back to the inferior vena cava (IVC) and aorta in the normal anatomic position.…”