Abstract

Introduction: Incarcerated inguinal hernias that cause obstruction of the ipsilateral ureter are an uncommon pathology that must be treated urgently to prevent life-threatening complications as well as to preserve renal function for the affected kidney. In this case study, we examine the question of whether the afflicted patient should be treated first with nephrostomy tube followed by surgery, or if immediate inguinal hernia repair should take precedence.

Case Presentation: A 50-year-old man presents to the emergency department with complaints of a chronic large right-sided inguinal mass and associated inguinal pain. A decreased glomerular filtration rate (GFR), presence of a significant right hydroureter at the level of the inguinal canal, and evidence of incarcerated inguinal hernia contents prompted emergency surgical exploration and repair.

Clinical Findings and Investigations: Given the physical exam correlated with imaging findings in addition to laboratory studies, the differential diagnosis of an incarcerated inguinal hernia involving the ureter was prioritized. Intraoperatively, the dilated ureter was visualized and separated from the hernia sac and the presumed diagnosis was visually confirmed.

Interventions and Outcome: Clinical experience and judgment were used when determining that emergent surgery was the priority intervention with the hope and expectation that the surgical intervention would also resolve the hydroureter and acute kidney injury (AKI) without need for further intervention. Intraoperatively, the bowel was reduced and ultimately the defect was repaired with mesh. Postoperatively, the patient passed multiple kidney stones, experienced resolution of pain, and a normalization of key lab findings, suggesting relief of the ureteral obstruction. The patient’s renal function quickly returned to normal following surgical intervention and no further urological treatment was necessary.

Relevance and Impact: In an emergency setting, the need for patients with incarcerated inguinal hernias involving the ureter to have surgical intervention should supersede the need for nephrostomy tube placement. Additionally, this study suggests the necessity of considering herniation of the ureter in the differential diagnosis of patients known to have an inguinal hernia that also present with AKI or hydroureter. Finally, this case reminds the general surgeon of the need to identify the ureter during hernia repair in which the ureter is suspected to be involved in order to prevent complications.

Keywords: Hydroureter; Nephrostomy; Incarcerated; Emergency; Ureteral Herniation; Inguinal Hernia

References

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Citation

Citation: Rodolfo J Oviedo., et al. “A Case Report on Right Hydroureter from an Incarcerated Inguinal Hernia in a Male Patient: Nephrostomy Tube or Surgery?”. Acta Scientific Gastrointestinal Disorders 4.2 (2021): 06-10.

Copyright

Copyright: © 2021 Ashish K Mishra. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.