Bochdalek hernia with obstructive uropathy

Ureteral Diaphragmatic Hernia Treated with Ureteral Stenting: A Case Report and Review of the Literature

Ureteral diaphragmatic hernia through diaphragmatic defects is an exceptionally rare subset of ureteral hernia with only fourteen such cases reported in English manuscripts. An 85-year-old woman was introduced to our department with right flank pain, fever elevation, and nausea. Urinalysis showed bacteriuria, and Escherichia coli was detected in the urine culture. Blood analysis revealed abnormal findings, including elevated WBC count (10,510/μl) and C-reactive protein (0.28 mg/dl). Computed tomography (CT) of the abdomen demonstrated a defect of the right diaphragmatic crus containing a dilated right ureter with associated hydronephrosis. Retrograde pyelography showed hydronephrosis and dilated ureter loops through the defect of diaphragmatic crus, known as a “curlicue sign,” and the diagnosis was right ureteral diaphragmatic hernia. A ureteral stent was placed on her right side, and the ureter was reducted into the retroperitoneal space. After six months, the ureteral stent was removed, with no subsequent recurrence of the ureteral diaphragmatic hernia at seven months. We reviewed all cases in the literature published in English of ureteral diaphragmatic hernia. While the etiology of ureteral diaphragmatic hernia is unknown, our present case and previous reports suggest that a ureteral diaphragmatic hernia may occur due to hepatic atrophy and/or an elevated position of the right kidney.

A Rare Case of Isolated Ureteral Diaphragmatic Herniation: Case Report and Review of Literature

Diaphragmatic ureteral hernias are rare causes of ipsilateral renal obstruction. Management strategies varies from conservative to ureteral stenting to operative herniorraphy and reduction. We present a case of a 71-year-old man who was found to have an incidental right ureteral diaphragmatic herniation causing an asymptomatic kidney obstruction. He was managed conservatively with no evidence of increased hydronephrosis on serial imaging and no deterioration of biochemical renal function. We review all similar cases published in the literature and discuss the optimal treatment strategies.

Herniation of the Right Renal Pelvis through a Posterolateral Diaphragmatic Defect (Bochdalek Hernia)

Diaphragmatic herniations are the rarest form of ureteral herniations with only around 9 cases reported since 1958.^1-10 Though uncommon, it should be considered in the differential diagnosis of a posterior diaphragmatic or paraspinal opacity with associated hydronephrosis. Correct diagnosis is of paramount importance and can be easily established by noninvasive imaging technique. In symptomatic individuals, laparoscopic intervention can be offered with good results in fit patients with ureteral stenting reserved for poor surgical candidates. Here we present a successful laparoscopic management of an elderly female who presented with right flank pain and was diagnosed with a right sided diaphragmatic ureteral herniation.

A rare diaphragmatic ureteral herniation case report: endoscopic and open reconstructive management

BACKGROUND

Ureteral herniations are a rare occurrence, generally found incidentally on cross sectional imaging or during surgical intervention for unrelated processes. Several locations of ureteral herniations can occur including the inguinal, femoral, sciatic, obturator, and thoracic regions. While few reports of ureteral hernias are reported in the literature overall, the vast majority of those reported are inguinoscrotal herniations found during evaluation and treatment of inguinal hernias. Pelvic outlet ureteral herniations intrinsically are more common secondary to their dependent locations. Intrathoracic ureteral herniations through diaphragmatic defects are an exceptionally rare subset of ureteral herniations and have only been described sparingly. Fewer than ten case reports of diaphramatic ureteral herniations have been reported and none have described both cystoscopic management and open reconstruction.

CASE PRESENTATION

We report the case of a 81 year old female with flank pain who was found to have idiopathic diaphragmatic hernia with incarcerated proximal ureter. She had no prior injury or surgery that explained her clinical presentation. She was initially observed and then managed conservatively with ureteral stent exchanges. Ultimately she underwent open surgical repair of her diaphragmatic hernia, reduction, resection and anastomosis of redundant proximal incarcerated ureteral segment, and nephropexy for a hypermobile right renal unit. This case report illustrates the pre- and post-operative imaging studies of a very rare intrathoracic ureteral herniation as well as surgical approach to repair.

CONCLUSION

A herniated ureter is a potential source of serious renal and ureteral complications. The thoracic herniation of ureter is the rarest of the ureteral herniations. When discovered, they should be managed to preserve renal function and prevent strangulation of the affected segment of ureter. This case report documents the treatment of a thoracic ureteral herniation with observation, conservative endoscopic management, and finally open surgical reconstruction.

Bochdalek-type Diaphragmatic Hernia Leading to High-grade Kidney Obstruction

A 94-year-old female presented with sharp right flank pain. Imaging demonstrated herniation of the right renal pelvis and proximal ureter into a large diaphragmatic hernia. She underwent ureteral stent placement with resolution of her symptoms. Congenital diaphragmatic hernias can cause a variety of pulmonary, cardiac, and gastrointestinal symptoms. This is 1 of only 3 cases in the literature of unilateral kidney obstruction due to herniation of the renal pelvis and proximal ureter into a Bochdalek-type diaphragmatic hernia. Ureteral stenting is a good option to decompress the kidney. Hernia reduction and primary diaphragm repair remain the definitive treatment.

Ureteral Hernia Mimicking Retrocrural Lymphadenopathy in 18F-FDG PET/CT

An 82-year-old woman was submitted to (18)F-FDG PET/CT to evaluate an indeterminate solitary lung nodule identified on chest CT. At the examination, there was a hypermetabolic area at the topography of the right retrocrural region, mimicking a lymphadenopathy on axial images. After careful analysis of multiplanar CT images, it was better characterized as a loop of the ureter insinuating itself by a small diaphragmatic hernia. Ureteral hernia is a rare entity with few cases reported in the literature. This case demonstrates the importance of conducting careful evaluation of multiplanar CT images to avoid false-positive results on PET/CT.

Right-sided Bochdalek hernia causing septic ureteric obstruction. Percutaneous treatment with placement of a nephroureteral double pigtail

We report a case of an 86-year-old female patient who presented with a septic, right ureteric obstruction, caused by a symptomatic Bochdalek hernia. The patient was initially managed with percutaneous nephrostomy and final treatment was achieved by placement of an external-internal nephroureteral double pigtail.