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Case Reports
. 2018 Jan 17:5:2054358117753620.
doi: 10.1177/2054358117753620. eCollection 2018.

As in Real Estate, Location Is What Matters: A Case Report of Transplant Ureteral Obstruction Due to an Inguinal Hernia

Ann Bugeja  1 , Edward G Clark  1 , Manish M Sood  1 , Sohrab N Ali  2
Affiliations
Case Reports

As in Real Estate, Location Is What Matters: A Case Report of Transplant Ureteral Obstruction Due to an Inguinal Hernia

Ann Bugeja et al. Can J Kidney Health Dis. .

Abstract
in English, French

Background: Kidney allograft dysfunction is common and often reversible but can lead to allograft loss if not promptly evaluated. Transplant ureteral obstruction in an inguinal hernia is a rare cause of allograft dysfunction, but early recognition may prevent allograft loss.

Case presentation: We present a case of a man with acute kidney allograft dysfunction who received a deceased donor kidney transplant 6 years earlier for end-stage kidney disease secondary to polycystic kidney disease. Abdominal ultrasounds revealed hydronephrosis without full visualization of the transplant ureter. Abdominal computed tomography revealed moderate hydronephrosis of the transplant kidney due to obstructed herniation of the transplant ureter in a right inguinal hernia. A stent was inserted into the transplant ureter to prevent further allograft dysfunction and facilitate hernia repair.

Conclusions: Transplant ureteral obstruction is a rare cause of acute kidney allograft dysfunction, and its detection can be challenging. The recognition of transplant ureteral obstruction is vital to timely management for preventing allograft loss.

Contexte: Les dysfonctionnements des allogreffes rénales sont fréquents, quoique souvent réversibles. Ils peuvent toutefois mener à la perte du greffon s’ils ne sont pas décelés rapidement. En présence d’une hernie inguinale, la détection précoce de l’obstruction de l’uretère du greffon, une cause rare de ces troubles fonctionnels, peut prévenir la perte du rein greffé.

Présentation du cas: Nous exposons le cas d’un homme ayant reçu, six ans plus tôt, une greffe de rein provenant d’un donneur décédé pour soigner une insuffisance rénale terminale résultant d’une polykystose rénale. Le patient présentait un cas aigu de dysfonctionnement du greffon. L’échographie abdominale a révélé la présence d’une hydronéphrose sans que l’uretère soit complètement visible. La tomodensitométrie abdominale a quant à elle révélé une hydronéphrose modérée dans le rein transplanté due à l’obstruction de l’uretère dans l’hernie inguinale du côté droit. Une endoprothèse a été insérée dans l’uretère du greffon pour empêcher l’aggravation des troubles fonctionnels et pour faciliter la réparation herniaire.

Conclusion: L’obstruction de l’uretère est une cause rare du dysfonctionnement aigu d’un rein transplanté, et sa détection peut représenter un véritable défi. Le diagnostic de ce type d’occlusion est crucial pour intervenir rapidement et ainsi prévenir la perte du greffon.

Keywords: acute kidney injury; allograft dysfunction; hernia; kidney transplantation; ureteral obstruction.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Ultrasound images of transplant kidney 1 week prior to admission, demonstrating mild hydronephrosis and incomplete visualization of distal ureter (A, B). Repeat ultrasound upon admission demonstrating interval worsening of hydroureteronephrosis (C).
Figure 2.
Figure 2.
Abdominal computed tomography in coronal view, demonstrating moderate hydroureteronephrosis (1), herniation of the transplant ureter (2) through inguinal ring (arrow), and the urinary bladder (3).
Figure 3.
Figure 3.
Abdominal computed tomography in axial view, demonstrating a dilated ureter (1) in right inguinal canal (arrow). The contralateral normal inguinal canal can be visualized.
See this image and copyright information in PMC

References

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