Challenging differential diagnosis, Rare disease
Karisa Beebe, John Muhonen, Pablo Giuseppucci, Christopher Esper
Department of Surgery, University of Pittsburgh Medical Center, Pittsburg, PA, USA
Am J Case Rep 2021; 22:e930911
Available online: 2021-08-02
Ureteroinguinal hernias are exceptionally rare and are seldom diagnosed in the preoperative setting. There are 2 classifications of this type of hernia: paraperitoneal and extraperitoneal.
CASE REPORT: We report a case of a 67-year-old man who presented with urinary symptoms and a reducible right inguinal hernia. A computed tomography (CT) scan of the abdomen and pelvis suggested an ureteroinguinal hernia. Further diagnostics and treatment via cystoscopy, retrograde pyelogram, and right ureteral stent placement were performed, confirming the diagnosis and providing relief of the obstructive uropathy. The patient underwent an attempted elective transabdominal preperitoneal repair that was converted to an open Lichtenstein repair. Intraoperatively, an extraperitoneal ureteroinguinal hernia was identified. The patient did well postoperatively, and the stent was removed 1 month later.
CONCLUSIONS: Only 20% of the ureteroinguinal hernias described in the literature are extraperitoneal. In our case presentation, we demonstrated successful identification and treatment of an extraperitoneal ureteroinguinal hernia. The diagnosis was made using a combination of the clinical presentation, CT of the abdomen and pelvis, and cystoscopy with retrograde pyelogram. The extraperitoneal classification was an intraoperative diagnosis. The treatment consisted of a temporizing ureter stent and definitive management with an open Lichtenstein repair. We recommend obtaining a CT scan when a patient presents with a combination of urinary symptoms and an inguinal hernia because this process was invaluable in our preoperative diagnosis. Stent placement at the time of diagnosis permitted an elective repair and aided in the identification of the ureter during the hernia repair.
Keywords: Hernia, Inguinal, herniorrhaphy, Ureteral Diseases