Unexpected Ureter Within an Inguinal Hernia

Abstract

Inguinal hernias containing a ureter are a rare occurrence. They are rarely diagnosed pre-operatively and can lead to serious complications if inadvertently damaged during hernia repair. We present the case of a 36year-old obese male who was found to have a ureter within his inguinal hernia intra-operatively. Due to imaging performed at another hospital, we have both pre and post-operative imaging demonstrating the ureter, its course into the inguinal hernia and its subsequent reduction back into the retroperitoneal space. We discuss the epidemiology of this phenomenon, the clinical implications and methods that have been suggested for pre-operative diagnosis.

Management of an obstructing calculus in an anticoagulated patient with a ureteral hernia

“…Careful dissection of this fat then reveals a white tubular structure which, when stimulated, exhibits visible peristalsis. 2 , 3 , 5 , 8 , 9 Another surgeon went so far as to intraoperatively perform fine needle aspiration of the cord, generating a urine-like fluid from the tube, confirming its identity as the ureter. 2 Awareness of possible ureteral entrapment in an inguinal hernia and careful consideration of the aforementioned qualities may avoid inadvertent injury to the ureter.…”

“… 1 Even so, ureteral involvement in an inguinal hernia is an infrequent finding, with less than 150 cases described in English literature as of 2023. 2 When ureteroinguinal hernias do occur, they are most often described in males in the fifth to sixth decade of life with obesity and a congenital ectopic kidney, due to the possible pelvic location and redundancy of the ureter, listed as risk factors. 3 , 4 , 5 Ureteroinguinal hernias can include the ureter alone, but are also frequently found in conjunction with other sliding abdominal organs, including the bladder or bowels.…”

“… 5 , 11 This was previously reported to account for 20 % of ureteroinguinal hernias, but many recent case reports describe this occurrence, whether due to prevalence or publication bias. 2 …”

“…Additionally, presence of a particularly large right sided inguinoscrotal hernia may warrant suspicion given the relation of the left ureter and the Fascia of Toldt. 2 …”