Rare case of inguinal ureteral hernia in a child diagnosed by drip infusion pyelography-computed tomography

Toshifumi Hosoda; Kohei Hijikata; Shigeki Ishioka

doi:10.1016/j.ijscr.2022.107007

Rare case of inguinal ureteral hernia in a child diagnosed by drip infusion pyelography-computed tomography

Int J Surg Case Rep. 2022 May:94:107007. doi: 10.1016/j.ijscr.2022.107007. Epub 2022 Apr 9.

Authors

Toshifumi Hosoda¹, Kohei Hijikata², Shigeki Ishioka²

Affiliations

¹ Department of Surgery, Teikyo University Hospital, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan. Electronic address: toshifumi.hosoda@med.teikyo-u.ac.jp.
² Department of Surgery, Teikyo University Hospital, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan.

Abstract

Introduction and importance: Inguinal hernias are the most commonly experienced disease in pediatric surgery. However, it is rare for the organs of the urinary system to prolapse as the contents of the hernia.

Case presentation: We report a case of a 14-year-old boy with congenital paraperitoneal inguinal herniation of the ureter. Intraoperatively, we found an unfamiliar tubular loop structure arising from the deep inguinal ring in the left inguinal canal. The tubular structure, which may have been part of the ureter, was left in the inguinal canal to avoid damage. Postoperative drip infusion pyelography-computed tomography showed anatomical irregularity of the ureter in the inguinal canal. Follow-up in the 5th postoperative year showed no recurrence of hydrocele and complications associated with ureteral obstruction.

Clinical discussion: Inguinal ureteral hernias are rarely reported in children. Paraperitoneal inguinal hernias are reported to be associated with vesicoureteral reflux and posterior urethral valve. Patients rarely present with symptoms like those observed in our case report. Whilst general surgical treatment is to return the ureter to the retroperitoneal space, we opted to leave the ureter in the inguinal canal to avoid unnecessary damage. However, this intraoperative management resulted in slight hematuria. The ureter should be placed back where it belongs, and postoperative monitoring using computed tomography may be important.

Conclusion: This case provides valuable insight into preoperative diagnostic difficulties and intra- and postoperative management of an inguinal ureteral hernia in children, highlighting the importance of accurate diagnosis and appropriate surgical intervention in the treatment of this disease.

Keywords: Inguinal hernia; Sliding hernia; Ureteral hernia.