Urosepsis secondary to ureterosciatic hernia corrected with ureteral stent placement: a case report and literature review

Abstract

Background Ureterosciatic hernia is a rare type of pelvic floor herniation that occurs through the sciatic foramen. The resulting ureteral obstruction may lead to hydronephrosis and to further complications including urinary tract infection and urosepsis. There have been 30 reported cases of ureterosciatic hernia. Ureteral stenting and surgical repair have been used as treatment options. Case presentation We report the case of an 86-year-old woman who was transferred to Tokyo Metropolitan Bokutoh Hospital with symptoms of fever and septic shock. Her computed tomography scan revealed left hydronephrosis and deviation of the left ureter into the sciatic foramen; she was therefore diagnosed with a left ureteral sciatic hernia and admitted in our intensive care unit for further treatment with resuscitative fluids, vasopressors, and antibiotics. Following a retrograde insertion ureteral catheter insertion, ureteral incarceration was relieved, and a double-J ureteral stent was placed in situ. Antibiotic treatment was initiated, and the patient’s hemodynamic status gradually improved. Conclusions Although ureterosciatic hernia is a rare disorder, it is associated with serious complications including urinary tract infection with sepsis, which may warrant urgent corrective procedure to relieve the structural obstruction. Treatment may be conservative or surgical, though treatment with ureteral stent placement may be a favorable approach in elderly patients with multiple comorbidities presenting with urosepsis.

Robotic-Assisted Repair of a Ureterosciatic Hernia with Combined Ureteral Stenting

“…Suggested explanations include the greater length of the left than right ureter and more pressure in the left side of the colon in patients with chronic constipation. 1 , 2 , 6 , 7 As the sciatic foramen is covered superficially by the gluteal muscles, a palpable bulge is not often appreciated. Obstructive and neuropathic symptoms may be intermittent, so diagnosis is often made using CT imaging.…”

“…With intestinal or ureteral perforation, sepsis or a contained abscess are also possible presentations. 2 – 4 , 6 , 7…”

“…For ureterosciatic hernias presenting with septic shock, emergent ureteral stent placement to straighten and reduce the ureter has been described with successful resolution of sepsis. 2 …”

Uretero-Sciatic Hernia (Lindbom Hernia): A Case Report and Long-Term Follow-Up

“…A ureteric herniation is generally a rare event, with the majority of cases being part of inguinoscrotal hernias. Historically, cases were incidentally reported intraoperatively during surgeries for inguinal hernias repair [ 1 ]. Herniation of the ureter through the sciatic foramina is extremely rare compared to inguinoscrotal herniation of ureters with less than 40 cases reported [ 2 ].…”

Erfolgreiche laparoskopische roboterassistierte operative Therapie bei beidseitigen ureteroischialen Hernien (Lindbom's Hernie) und Beckenniere

“…In einer Akutsituation, in welcher eine Harnableitung indiziert ist, kann eine Nephrostomie-Anlage oder Harnleiterschienung vorgenommen werden [1].…”