Yeungnam Univ J Med.  2020 Oct;37(4):337-340. 10.12701/yujm.2020.00402.

Ureterosciatic hernia causing obstructive uropathy successfully managed with minimally invasive procedures

• Kim YU
• Cho JH
• Song PH

• KMID: 2508181
• DOI: http://doi.org/10.12701/yujm.2020.00402

Abstract

Ureterosciatic hernia is extremely rare. In ureteral herniation, ureter prolapses occur through either the greater or lesser sciatic foramen. Atrophy of the piriformis muscle, hip joint diseases, and defects in the parietal pelvic fascia are predisposing factors for the development of ureterosciatic hernia. Most symptomatic patients have been treated surgically, with conservative treatment reserved only for asymptomatic patients. To the best of our knowledge, long-term follow-up outcomes after ureterosciatic hernia management are sparse. In this paper, we report the case of a 68-year-old woman who presented with colicky left abdominal pain. After computed tomography (CT) scan and anterograde pyelography, she was diagnosed ureterosciatic hernia with obstructive uropathy. We performed ureteral balloon dilatation and double-J ureteral stent placement. After this minimally invasive procedure, CT scan demonstrated that the left ureter had returned to its normal anatomical position without looping into the sciatic foramen. The patient remained asymptomatic with no adverse events 7 years after the minimally invasive procedures. This brief report describes ureterosciatic hernia successfully managed with minimally invasive procedures with long-term follow-up outcomes.

Keyword

Hernia; Minimally invasive surgical procedures; Treatment outcome; Ureter

Figure

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  Fig. 1. Postcontrast axial (A), coronal (B) computed tomography (CT), and a left anterograde pyelography (AGP, C) show left hydronephroureter with herniation into sciatic foramen (arrows). These CT and AGP reveal a 'curlicue ureter' sign as the knuckle of the herniated ureter passed laterally to the medial wall of the pelvis (arrows).

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  Fig. 2. A left retrograde pyelography reveals a 'curlicue ureter' sign as the knuckle of the herniated ureter (A, arrow). Ureteral balloon dilation is performed in this herniated ureter (B) and left double-J ureteral stent is placed after ureteral balloon dilation (C).

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  Fig. 3. Follow-up postcontrast coronal computed tomography shows the left ureter was no longer looped into the sciatic foramen and had returned to its normal anatomical position (arrow).

Reference

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