Inguinal ureter herniation evaluated with magnetic resonance imaging: a case report
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(2020) 14:202
CASE REPORT
Open Access
Inguinal ureter herniation evaluated with magnetic resonance imaging: a case report Matteo Renzulli1, Guido Marzocchi1, Giulio Vara1* , Beniamino Corcioni1, Anna Maria Ierardi2, Caterina Gaudiano1 and Rita Golfieri1
Abstract Background: The herniation of the ureter into the inguinal canal is a rare condition, but probably underreported. Acquired nephroptosis could cause herniation of the ureter and, therefore, when diagnosed, a full study of the urinary tract should be performed especially in patients with inguinal hernia. Case presentation: We present the case of an 86-year-old white man with a herniated ureter likely caused by acquired nephroptosis presenting with acute urinary retention, documented with magnetic resonance imaging for the first time. Conclusions: The Fast Imaging Employing Steady State Acquisition sequence on magnetic resonance imaging, for many reasons, could allow correct evaluation of the urinary tract, especially in cases of renal dysfunction that contraindicate the use of intravenous contrast agents. Keywords: Case reports, Emergency service, General surgery; hernia, inguinal, Magnetic resonance imaging, Ureter
Background Inguinoscrotal herniation of the ureter (native or transplanted) is an extremely rare medical condition [1], usually related to congenital abnormalities or to postoperative anatomical alterations [2]. Most (80%) ureteral inguinal hernias are paraperitoneal, meaning that an anteromedial hernial sac is present with the ureter that is drawn into the canal along the posterior aspect of the peritoneum, while some 20% of cases of ureteral inguinal hernias are extraperitoneal, meaning that a true hernial sac is not present and the ureter is accompanied by retroperitoneal fat only. Most reported cases are noted at the time of surgical exploration for inguinal hernia repair, or later as a result of an operative injury [3]. Therefore, awareness of this anomaly is important, to avoid ureteral injury during herniorrhaphy if the anomaly is asymptomatic, and to correctly diagnose it as a * Correspondence: [email protected] 1 Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, Bologna, Italy Full list of author information is available at the end of the article
possible cause for acute ipsilateral hydronephrosis in an emergency setting.
Case presentation An 86-year-old white man, with a pathological history of right kidney stones, presented to the emergency room of our University Hospital with right flank pain of 2 days’ duration, radiating to the ipsilateral inguinal fossa with concomitant acute urinary retention, worsening constipation, and mild dyspnea. Our patient was affected by known bilateral massive inguinoscrotal hernias, hydrocele, and benign prostatic hyperplasia and, therefore, he was scheduled for elective hernioplasty and prostatectomy. On physical examination, our patient presented a distended, diffusely painful abdomen with metallic peristalsis; however
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