An inguinoscrotal hernia is a common disorder that usually contains intraperitoneal organs (small intestine, colon, appendix, ovaries). Extraperitoneal ureteral herniation into an inguinoscrotal hernia is a rare condition and often associated with congenital abnormalities or postoperative anatomic changes. A high index of suspicion is needed in order to avoid intraoperative ureteric injuries. We herein report the case of a ureteric herniation into an inguinoscrotal hernia incidentally found during a scheduled hernia repair.

Asymptomatic extraperitoneal inguinoscrotal hernia involving ureter: A case presentation and review of the literature

Worldwide, there are more than 20 million inguinal hernia repairs performed annually. About 800,000 of these are performed in the United States. These statistics make inguinal hernias one of the most common medical conditions encountered by a general surgeon. The ureter is a retroperitoneal organ, and ureteral involvement with an inguinal hernia is rare. Only about 140 cases of ureteroinguinal were reported through 2009. Involvement of the ureter may be undetected preoperatively, and the general surgeon needs to be keenly aware of a ureteroinguinal hernia because intra-operative iatrogenic damage to the ureter can have serious consequences.

Adult Inguinal Hernia

Inguino-scrotal herniation of the ureter is a rare and difficult situation for a surgeon, especially if only recognized during inguinal hernia repair. An 83-year-old gentleman, with a previous history of radiation treatment for squamous anal cancer, presented with a large left inguinoscrotal hernia causing occasional pain at the base of the scrotum. Follow-up, post-radiation therapy CT scan showed a hernia sac containing the bladder and large bowel. Calcifications in the sac were interpreted as bladder stones, in keeping with the history of left renal calculi. During hernia repair careful dissection revealed a herniated portion of the left ureter located alongside a large hernia sac, complicated by ureteral calculi. Following stones extraction and ureteral repair, hernia repair with mesh was successfully accomplished. Pathogenesis of ureteric herniation is reviewed. A herniated ureter is potentially a source of serious renal or ureteral complications. When discovered, ureteric hernias should be surgically repaired. If preoperative detection of a ureter herniation alongside an inguinal hernia is missed, awareness of the existence of this condition may help avoid iatrogenic ureteral damage injury during a complex hernioplasty. Documentation of unexplained, sizeable and distinct calcifications in an inguino-scrotal hernia sac, particularly in a patient with a history of urolithiasis, may suggest the presence of a herniated, calculus-filled ureter. In such cases, retrograde pyelograms may be considered for a definitive diagnosis prior to surgery.

Inguino-scrotal herniation of the ureter containing stones

Inguinal hernias are a common disease in adults, but involvement of extraperitoneal structures is rare. This condition is usually asymptomatic and an incidental finding during the surgical correction of inguinal hernias, often resulting in iatrogenic damage. We present a rare case of left renal agenesis and right inguinal hernia, with the ureter being the only organ protruding as an inguinal hernia, diagnosed in the preoperative period.

/pdf/inguinal-hernia-with-ureter-in-patient-with-single-kidney-1tatgxtl8p.pdf

Inguinal hernia with ureter in patient with single kidney

https://digitalcommons.wustl.edu/cgi/viewcontent.cgi?article=5828&context=open_access_pubs

A sign on CT that predicts a hazardous ureteral anomaly

Herniation of a ureter in an inguinal canal and scrotum is rare, and the general surgeon should be aware of this possibility to avoid injury to the ureter during hernial dissection. There are 2 types of inguinoscrotal herniation of a ureter: paraperitoneal (with a peritoneal hernial sac) and extraperitoneal (without a hernial sac).1 We report a case of the rarer form in which extraperitoneal herniation of the ureter in the left inguinal canal reached the upper pole of the testis and was misdiagnosed as a varicocele.

http://canjsurg.ca/wp-content/uploads/2014/03/52-2-E29.pdf

Inguinoscrotal extraperitoneal herniation of a ureter

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Inguinoscrotal extraperitoneal herniation of a ureter