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Case Reports
. 2020:77:161-164.
doi: 10.1016/j.ijscr.2020.10.127. Epub 2020 Nov 2.

Laparoscopic approach to ureteroinguinal hernia

Praveen Lakshmi Narayanan  1 , Narayanan C D  2 , Vishnu Sekar  3 , Akshita Reddy Vadyala  4
Affiliations
Case Reports

Laparoscopic approach to ureteroinguinal hernia

Praveen Lakshmi Narayanan et al. Int J Surg Case Rep. 2020.

Abstract

Introduction: Herniation of the ureter into the inguinal canal is a rare occurrence. There have been reports of inadvertent injury to the ureter during routine inguinal hernia repair. After an extensive search of the literature, we believe that this is the first case to be managed via laparoscopic Trans Abdominal Pre-Peritoneal Repair and would like to highlight the technical details of the laparoscopic procedure and is presented in line with SCARE 2018 Guidelines [1].

Presentation of case: A 60-year-old male presented with left inguinal hernia. He also complained of an increase in frequency of micturition, with an occasional radiating pain from loin to the groin. Imaging revealed the left ureter coursing into the left inguinal canal, descending into the scrotum, and looping back to enter the bladder with mild hydroureteronephrosis. Patient underwent a laparoscopic repair of the inguinal hernia with reduction of ureter under ureteroscope guidance and stent placement.

Discussion: The presence of ureter buried in a large amount of fat can be mistaken for a lipoma of the cord or extraperitoneal fat and injured with blind clamping and division. Presence of fat without an obvious sac should alert the surgeon to the possibility of ureter being a content.

Conclusion: Laparoscopy is safe, technically feasible, offers good visualization of all hernial orifices, demonstrates complete reduction of ureter from inguinal canal under vision, allows manipulation of ureter under the vision for ureteroscopy and stenting, making sure there are no loops or kinking and allows placement of mesh in the preperitoneal space.

Keywords: Hydro-ureteronephrosis; Laparoscopic approach; Uretero-inguinal hernia.

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Figures

Fig. 1
Fig. 1
A plain CT of KUB showing the left ureter coursing into the left inguinal canal, descending into the scrotum, and looping back to enter the bladder (arrow).
Fig. 2
Fig. 2
At the level of the internal ring, there was a large tubular structure extensively covered by fat. I. White arrow showing the extraperitoneal fat surrounding the ureter. II. Black arrow showing tortuous ureter.
Fig. 3
Fig. 3
Figure showing tortuous ureter. (arrow).
See this image and copyright information in PMC

References

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