Transplant uretero-inguinal hernia resulting in urosepsis

Abstract

Uretero-inguinal hernias are rare and can be difficult to diagnose. We present a case of a rare transplant kidney uretero-inguinal hernia. An 81-year-old male presented with urosepsis and was found to have an obstructed transplanted kidney secondary to herniation of the ureter into an inguinal hernia. The patient required interventional radiology decompression of the urinary system with a percutaneous nephrostomy tube. In this case, the patient's uretero-inguinal hernia was the extraperitoneal subtype allowing the diagnosis to be made easily on computed tomography imaging of the abdomen and pelvis which facilitated rapid treatment.

Keywords: Hydroureteronephrosis; Nephrostomy; Nonvascular intervention; Uretero-inguinal hernia.

Fig. 1

Coronal (A) and sagittal (B) CT without contrast demonstrating moderate to marked hydroureteronephrosis of the right lower quadrant transplant kidney secondary to herniation of ureter into a right inguinal hernia. The yellow arrow points to the dilated renal collecting system. The red arrow points to the dilated transplant ureter within the right inguinal hernia.

Fig. 2

(A) Initial sonographic evaluation of the right lower quadrant transplant kidney demonstrating moderate hydronephrosis. (B, C) Intraprocedural fluoroscopic images of 8 Fr nephrostomy tube placement into hydronephrotic transplant kidney. The yellow arrow points to the dilated renal collecting system. The red arrow points to the guidewire that is within the transplant ureter. The orange arrow points to the final position of the nephrostomy tube.