Ureteral inguinal hernia: an uncommon trap for general surgeons

Abstract

Inguinal hernias involving the ureter, a retroperitoneal structure, is an uncommon phenomenon. It can occur with or without obstructive uropathy, the latter posing a trap for the unassuming general surgeon performing a routine inguinal hernia repair. Ureteral inguinal hernia should be included as a differential when a clinical inguinal hernia is diagnosed concurrently with unexplained hydronephrosis, renal failure or urinary tract infection particularly in a male. The present case describes a patient with a known ureteroinguinal hernia who proceeded to having a planned hernia repair and ureteric protection. The case is a reminder that when faced with an unexpected finding such an indirect sliding inguinal hernia, extreme care should be taken to ensure that no structures are inadvertently damaged and that a rare possibility is the entrapment of the ureter in the inguinal canal.

Inguinal Hernia Containing an Incarcerated Ureter of a Transplanted Kidney

“…It is possible that it is underreported as it usually causes no symptoms and presents as an incidental finding. The condition is more common in transplanted patients, particularly if the grafted ureter is too long, or if it crosses over, rather than under the spermatic cord 4,5 . The ureter may be involved in femoral hernia as well, although two times less likely than in inguinal hernias.…”

“…There are two types of ureteroinguinal hernia: paraperitoneal and extraperitoneal. The first, associated with kidney transplants, is believed to be acquired, due to the adhesions which attach ureter to the peritoneum that then drags it into hernial sac 5 . Extraperitoneal type is less common and presumably a result of congenital defect due to failed separation of ureteric bud from the Wolffian duct which leads to their joint migration to the scrotum.…”

Unilateral Renal and Spermatic Cord Agenesis Accompanying to the Ureteral Extraperitoneal Inguinal Herniation in An Infant

“…In contrast, the extraperitoneal type is considered a congenital embryonic defect that results in fusion between the ureter and the genitoinguinal ligaments due to failure of separation of the ureteric bud from the Wolffian duct. Both of which are then drawn down to the scrotum to form the epididymis and vas deferens [4]. The ureter is dragged into the inguinoscrotal region during physiologic descent of the testes.…”

Robot-Assisted Laparoscopic Repair of Extraperitoneal Ureteral Inguinal Hernia with Mesh Placement

“… 1 In contrast, indirect herniation of the ureter through the inguinal canal, although previously described, is extraordinarily rare with less than 150 cases reported in the literature. 2 Eighty percent of ureteral inguinal hernias are classified as paraperitoneal, and more rarely, 20% are purely extraperitoneal. 2–4 All prior reported cases of ureteral inguinal hernia have been repaired using an open surgical technique; some authors have claimed laparoscopic repair to be implausible.…”