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Mustafa M, Pouzi A, Senada P, Suraparaju L, Gupta S. Ureterosciatic Hernia in Focus: A Narrative Review of the Literature. Cureus 2023; 15:e49895. [PMID: 38174201 PMCID: PMC10762697 DOI: 10.7759/cureus.49895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Pelvic herniation of the ureter through anatomical musculoskeletal foramina stands out as one of the rarest causes of ureteric obstruction. Historically, most cases have been documented as incidental intraoperative findings. The herniation of the ureter through the sciatic foramen presents as a particularly uncommon variant of this condition, distinguished by its potential to cause life-threatening sepsis or renal failure if not promptly recognized and treated. The diagnostic process remains challenging, attributed partly to the vague initial symptomatology and subtle radiological findings, and second, to the rarity of this condition. This challenge may be further compounded by the lack of a clear description of clinical features and pathways to raise clinician suspicion. In light of these considerations, we conducted this literature review to illuminate this unique cause of obstructive uropathy, aiming to delineate its clinical features and explore common diagnostic and treatment options.
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Affiliation(s)
- Mohamed Mustafa
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
| | - Afiq Pouzi
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
| | - Peter Senada
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
| | - Lokesh Suraparaju
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
| | - Suresh Gupta
- Urology, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, GBR
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2
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Li B, Wang Y, Sun Y, Man Y, Zhang X. One case report of laparoscopic biological patch repair for the ureterosciatic hernia and literature review. Heliyon 2022; 8:e10488. [PMID: 36110237 PMCID: PMC9469662 DOI: 10.1016/j.heliyon.2022.e10488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/16/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
Abstract
Ureterosciatic hernia is a very rare disease worldwide. We report a successful case of laparoscopic biological repair of large ureteral hernia. Preoperative CT examination showed ureterosciatic hernia with incarceration and proximal ureteral dilatation. Laparoscopic ureteral incarceration release, ureteral stent placement and biological patch repair of sciatic foramen hernia were performed. Under the observation of laparoscope, the stent was placed through urethra with cystoscope to restore the course of ureter. A biological patch was placed behind the ureter to cover the closed hernia ring. We have been followed up for 2 months after operation. According to the reexamination, the effect is obvious. Laparoscopic biological patch repair for ureteral sciatic foramen hernia has the advantages of less trauma, convenient operation and ideal prognosis in theory.
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Kakimoto K, Hikone M, Nagai K, Yamakawa J, Sugiyama K, Hamabe Y. Urosepsis secondary to ureterosciatic hernia corrected with ureteral stent placement: a case report and literature review. Int J Emerg Med 2021; 14:67. [PMID: 34742226 PMCID: PMC8572418 DOI: 10.1186/s12245-021-00392-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ureterosciatic hernia is a rare type of pelvic floor herniation that occurs through the sciatic foramen. The resulting ureteral obstruction may lead to hydronephrosis and to further complications including urinary tract infection and urosepsis. There have been 30 reported cases of ureterosciatic hernia. Ureteral stenting and surgical repair have been used as treatment options. CASE PRESENTATION We report the case of an 86-year-old woman who was transferred to Tokyo Metropolitan Bokutoh Hospital with symptoms of fever and septic shock. Her computed tomography scan revealed left hydronephrosis and deviation of the left ureter into the sciatic foramen; she was therefore diagnosed with a left ureteral sciatic hernia and admitted in our intensive care unit for further treatment with resuscitative fluids, vasopressors, and antibiotics. Following a retrograde insertion ureteral catheter insertion, ureteral incarceration was relieved, and a double-J ureteral stent was placed in situ. Antibiotic treatment was initiated, and the patient's hemodynamic status gradually improved. CONCLUSIONS Although ureterosciatic hernia is a rare disorder, it is associated with serious complications including urinary tract infection with sepsis, which may warrant urgent corrective procedure to relieve the structural obstruction. Treatment may be conservative or surgical, though treatment with ureteral stent placement may be a favorable approach in elderly patients with multiple comorbidities presenting with urosepsis.
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Affiliation(s)
- Kohei Kakimoto
- Tertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
| | - Mayu Hikone
- Tertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Ko Nagai
- Tertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Jun Yamakawa
- Tertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center (Trauma and Critical Care), Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
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4
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Zeng F, Shames B, Appel E, Varalakshmi N, Mortensen E, Maheshwari N. Bilateral sciatic hernias in an elderly woman successfully managed with robotic surgery: A case report and literature review. Int J Surg Case Rep 2021; 86:106333. [PMID: 34454211 PMCID: PMC8405977 DOI: 10.1016/j.ijscr.2021.106333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Sciatic hernias are the rarest form of pelvic floor hernias as well as an uncommon cause of sciatica. A high index of suspicion is required to make the diagnosis due to its variable clinical presentation. This is the first case describing bilateral intestinal sciatic hernia, diagnosis, and robotic surgical repair. Presentation of case A 77-year-old female with history of chronic back pain and diverticulitis presented with three weeks of abdominal pain, radiating down her legs bilaterally. Computed tomography (CT) revealed bilateral sciatic notch hernias without evidence of bowel obstruction. Magnetic resonance imaging (MRI) confirmed compression of the sciatic nerves within the sciatic notch bilaterally. She underwent robotic bilateral retroperitoneal sciatic notch hernia repair successfully. Discussion There are several independent causes of abdominal pain and bilateral radiating leg pain. Sciatic hernias are an unusual cause of both. Aside from bowel, the hernia can involve other structures, such as the bladder, ureters, or ovaries, potentially creating drastically different clinical pictures. Laparoscopic or robotic repair have been proven superior to open surgery in the literature. Conclusion This case demonstrates that bilateral sciatic hernias can present as uncomplicated sciatica in an elderly patient, but the addition of seemingly unrelated abdominal pain should warrant further investigation. Minimally invasive robotic repair can successfully treat sciatic hernias. Sciatic hernias are the rare pelvic floor hernias with variable presentations. First case of diagnosis and surgical repair of bilateral sciatic hernias Minimally-invasive robotic repair can successfully treat sciatic hernias.
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Affiliation(s)
- Francine Zeng
- University of Connecticut School of Medicine, Farmington, CT, United States
| | - Brian Shames
- Department of General Surgery, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Elizabeth Appel
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Niranjan Varalakshmi
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Eric Mortensen
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Narinder Maheshwari
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, United States.
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Sechrist E, Elmaoued A, Ong CJ, Trivedi S, Gerena M, Wagner R, Allam E. Ureterosciatic hernia with concomitant Amyand hernia: Case report and review of the literature. Radiol Case Rep 2021; 16:3134-3138. [PMID: 34457102 PMCID: PMC8377551 DOI: 10.1016/j.radcr.2021.07.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/18/2021] [Indexed: 11/29/2022] Open
Abstract
Ureterosciatic hernias are extremely rare, with fewer than 40 cases reported in the literature. We present a case of a patient with concurrent right ureterosciatic hernia (Lindbom hernia), ipsilateral bladder hernia, and appendix-containing inguinal hernia (Amyand hernia). These findings were discovered incidentally on imaging and the patient had no associated symptoms.
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Affiliation(s)
- Emma Sechrist
- Department of Radiology, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, USA
| | - Alaa Elmaoued
- Department of Radiology, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, USA
| | - Chiew-Jen Ong
- Department of Radiology, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, USA
| | - Surbhi Trivedi
- Department of Radiology, University of Illinois at Chicago, 1740 W Taylor St, Chicago, IL 60612, USA
| | - Marielia Gerena
- Department of Radiology, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, USA
| | - Robert Wagner
- Department of Radiology, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, USA
| | - Emad Allam
- Department of Radiology, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, USA
- Corresponding author. E Allam.
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Kim YU, Cho JH, Song PH. Ureterosciatic hernia causing obstructive uropathy successfully managed with minimally invasive procedures. Yeungnam Univ J Med 2020; 37:337-340. [PMID: 32723982 PMCID: PMC7606958 DOI: 10.12701/yujm.2020.00402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/08/2020] [Indexed: 11/06/2022] Open
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.
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Affiliation(s)
- Yeong Uk Kim
- Department of Urology, Yeungnam University Hospital, Daegu, Korea
| | - Jae Ho Cho
- Department of Radiology, Yeungnam University College of Medicine, Daegu, Korea
| | - Phil Hyun Song
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
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Lazaridis N, Anastasopoulos N, Zevgaridis A, Piagkou M, Natsis K. Accidental Ultrasound Finding of a Giant Intermuscular Gluteal Lipoma with Intrapelvic Extension: A Case Report. Cureus 2020; 12:e7143. [PMID: 32257688 PMCID: PMC7105270 DOI: 10.7759/cureus.7143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lipomas represent the most common benign mesenchymal tumor. They are usually located subcutaneously and rarely become symptomatic. Occasionally pressure symptoms on adjacent neurovascular structures may be exerted, thereby causing functional impairment. Lipomas rarely grow larger than 5 cm, becoming the so-called giant lipomas, posing a real diagnostic and surgical challenge. We report an unusual case of a 43-year-old Caucasian female with an accidental pelvic ultrasound finding of a giant mass, which was also palpable over the right gluteal region. Interestingly the patient was free of any sciatic nerve compression symptoms. Magnetic resonance imaging (MRI) revealed a soft tissue tumor, partially located in between the external rotator muscles of the hip and the gluteus muscle. The tumor forced up and advanced through the great sciatic foramen into the pelvis. The patient underwent an uneventful complete and safe surgical excision of the gluteal mass, via a wide transgluteal approach. Pathology confirmed lipoma diagnosis. Patient is free from recurrence two years post operatively. Physicians involved in the diagnosis and treatment of gluteal masses should always consider in their differential diagnosis the presence of a sciatic hernia.
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Affiliation(s)
- Nikolaos Lazaridis
- Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | | | | | - Maria Piagkou
- Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - Konstantinos Natsis
- Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
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8
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[URETEROSCIATIC HERNIA TREATED BY URETERAL STENT PLACEMENT]. Nihon Hinyokika Gakkai Zasshi 2019; 110:144-147. [PMID: 32307384 DOI: 10.5980/jpnjurol.110.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ureterosciatic hernia is an uncommon condition that can cause ureteral obstruction. Here, we report a case of ureterosciatic hernia successfully treated by ureteral stent placement. A 95-year old woman presented to our emergency department with high fever. An abdominal CT scan revealed mild left hydronephrosis and urinalysis identified pyuria. The patient was subsequently admitted to hospital with a diagnosis of complicated pyelonephritis. No recovery was evident after antimicrobial treatment, a repeat CT scan revealed a ureterosciatic hernia. We indwelled a left ureteral stent and repaired the hernia. We did not opt for a surgical approach because of the patient's age and presence of dementia. The stent was removed after 2 months, but the patient was re-admitted 4 months later because of pyelonephritis. Here, we indwelled a left ureteral stent, and the patient underwent regular ureteral stent exchange. Placement of a ureteral stent for ureterosciatic hernia is an effective treatment for elderly patients and those who are poor surgical candidates.
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9
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Gandhi J, Lee MY, Joshi G, Smith NL, Ali Khan S. Ureterosciatic hernia: An up-to-date overview of evaluation and management. TRANSLATIONAL RESEARCH IN ANATOMY 2018. [DOI: 10.1016/j.tria.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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10
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Cabarrus MC, Yeh BM, Phelps AS, Ou JJ, Behr SC. From Inguinal Hernias to Spermatic Cord Lipomas: Pearls, Pitfalls, and Mimics of Abdominal and Pelvic Hernias. Radiographics 2017; 37:2063-2082. [DOI: 10.1148/rg.2017170070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Miguel C. Cabarrus
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628 (M.C.C., B.M.Y., A.S.P., S.C.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, N.C. (J.J.O.)
| | - Benjamin M. Yeh
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628 (M.C.C., B.M.Y., A.S.P., S.C.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, N.C. (J.J.O.)
| | - Andrew S. Phelps
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628 (M.C.C., B.M.Y., A.S.P., S.C.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, N.C. (J.J.O.)
| | - Jao J. Ou
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628 (M.C.C., B.M.Y., A.S.P., S.C.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, N.C. (J.J.O.)
| | - Spencer C. Behr
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628 (M.C.C., B.M.Y., A.S.P., S.C.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, N.C. (J.J.O.)
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11
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Wai OKH, Ng LFH, Yu PSM. Ruptured Renal Pelvis Due to Obstruction by Ureterosciatic Hernia: A Rare Condition With a Rare Complication. Urology 2016; 97:e13-e14. [PMID: 27542861 DOI: 10.1016/j.urology.2016.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 06/23/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
Abstract
Ureterosciatic hernia is an extremely rare condition. Here we report a case of ureterosciatic hernia presented with sudden loin pain, with contrast computed tomography and antegrade pyelogram demonstrating ureterosciatic hernia causing ureteric obstruction and renal pelvic rupture. Subsequently, laparotomy with hernia reduction and mesh repair was performed.
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Affiliation(s)
- Ophelia Ka Heng Wai
- Department of Radiology and Organ Imaging, United Christian Hospital, Hong Kong.
| | | | - Peter San Ming Yu
- Department of Radiology and Organ Imaging, United Christian Hospital, Hong Kong
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12
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Chen YC. Sciatic hernia with incarcerated urinary bladder: Laparoscopic transabdominal extraperitoneal repair with a mesh plug. FORMOSAN JOURNAL OF SURGERY 2015. [DOI: 10.1016/j.fjs.2014.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Yanagi K, Kan A, Sejima T, Takenaka A. Treatment of ureterosciatic hernia with a ureteral stent. Case Rep Nephrol Dial 2015; 5:83-6. [PMID: 25960996 PMCID: PMC4395823 DOI: 10.1159/000380944] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A 92-year-old woman was referred to our hospital from a family practice with the chief of complaint of vomiting. Subsequent computed tomography imaging revealed left hydroureteronephrosis without clear evidence of ureteral stones or ureteral tumors and that the lower part of the ureter was shifted to the outside of the cavum pelvis minor from the greater sciatic foramen. Retrograde pyelography was performed, and the shadow of a mass, which constricted and obstructed the distal left ureter, was observed. The patient was diagnosed with ureterosciatic hernia, and a left retrograde ureteral stent was indwelled and the hernia was repaired. Cases of ureterosciatic hernia are very rare. We describe one case of ureterosciatic hernia and review the relevant literature.
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Affiliation(s)
- Koji Yanagi
- Department of Urology, Tsuyama Daiichi Hospital, Tsuyama, Yonago, Japan
| | - Akinobu Kan
- Department of Radiological Medicine, Tsuyama Daiichi Hospital, Tsuyama, Yonago, Japan
| | - Takehiro Sejima
- Department of Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Atsushi Takenaka
- Department of Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
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Kato T, Komiya A, Ikeda R, Nakamura T, Akakura K. Minimally Invasive Endourological Techniques may Provide a Novel Method for Relieving Urinary Obstruction due to Ureterosciatic Herniation. Case Rep Nephrol Dial 2014; 5:13-9. [PMID: 25849669 PMCID: PMC4294447 DOI: 10.1159/000366154] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Ureterosciatic herniation, the protrusion of the hernia sac through the sciatic foramen, is an extremely rare cause of ureteral obstruction. We describe a case revealed by severe left back pain in a 72-year-old female. She was referred to our hospital for urological assessment of left hydronephrosis observed by ultrasonography. Intravenous ureterography (IVU) showed findings compatible with a left sciatic ureter, a dilated ureter with a fixed kinking, which is known as the 'curlicue' sign. We decided to attempt recovery of the herniated ureter using a retrograde approach. Ureteral stent placement was performed to decompress the dilated upper urinary tract. The ureterosciatic hernia was relieved with the passage of a flexible guide wire and a double-pigtail stent. Three months after ureteral stenting, she refused continuing to have an indwelling stent and the stent was removed. Thereafter, IVU revealed recurrent ureterosciatic hernia; however, there was no hydroureter or hydronephrosis. The patient is currently being under observation for 6 years after stenting and continues to be without hydronephrosis or symptoms. Placement of an internal stent possibly provides the rigidity to the ureter, thereby reducing the hernia and urinary obstruction. In the previous reports, most symptomatic patients have been treated surgically, with conservative therapy reserved for asymptomatic patients. For the patient who is elderly or a poor surgical candidate, retrograde stenting may provide safe reduction and efficacious treatment. This endourological approach provides a minimally invasive means for the management of urinary obstruction caused by ureterosciatic herniation.
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Affiliation(s)
- Tomonori Kato
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama-shi, Tokyo, Japan ; Department of Urology, Tokyo Kosei Nenkin Hospital, Tokyo, Japan
| | - Akira Komiya
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama-shi, Tokyo, Japan
| | - Ryoichi Ikeda
- Department of Urology, Tokyo Kosei Nenkin Hospital, Tokyo, Japan
| | - Takeshi Nakamura
- Department of Urology, Tokyo Kosei Nenkin Hospital, Tokyo, Japan
| | - Koichiro Akakura
- Department of Urology, Tokyo Kosei Nenkin Hospital, Tokyo, Japan
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15
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Tai YS, Liu KL, Su MYM, Tai HC, Huang KH. Laparoscopic surgery to treat ureterosciatic herniation after ureteral stent failure. UROLOGICAL SCIENCE 2014. [DOI: 10.1016/j.urols.2013.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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16
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Dulskas A, Poskus E, Jurevicius S, Strupas K. Giant gluteal lipoma presenting as a sciatic hernia. Hernia 2013; 19:857-860. [PMID: 24233446 DOI: 10.1007/s10029-013-1184-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 10/31/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sciatic hernia is considered to be the rarest hernia of pelvic floor with less than one hundred reports published worldwide. Lipoma in the hernia sac is even more unique pathology with only few cases reported in the literature. We report a case of gluteal lipoma protruding into pelvis, displacing rectum with bladder and presenting as a sciatic hernia. CASE PRESENTATION A 53-year-old male presented with an expanding, slightly reducible, right gluteal painful mass, back pain, dull pressure in lower abdomen and perianal region radiating to the right buttock, urgent urination and defecation. Lower back pain lasts for more than 7 years, other symptoms-6 months. No spinal pathology was found on X-ray. On examination patient seemed well nourished, BMI 29, abdomen was soft, without palpable masses or signs of peritonitis. Digital rectal examination showed no pathology. There was a reducible lump on the lateral side of right gluteus. Computer tomography (CT scan) demonstrated a large intra- and extra-pelvic fatty mass traversing the greater sciatic foramen. The tumor was surgically removed through lower middle laparotomy approach. Subsequent pathological examination revealed lipoma. The patient recovered uneventfully, was discharged 8 days later. MRI scan was advised following 1 year after the surgery. CONCLUSION The presence of a gluteal mass should always suggest the possibility of a sciatic hernia.
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Affiliation(s)
- A Dulskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University Hospital, Santariskiu Clinics, 2 Santariskiu Street, 08661, Vilnius, Lithuania,
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17
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Yeung JTH, Ma JKF, Yung AWT, Cheng RLF. Idiopathic bilateral ureteric entrapment within the sacroiliac joints causing bilateral hydroureteronephrosis. Clin Radiol 2010; 65:662-5. [PMID: 20599070 DOI: 10.1016/j.crad.2010.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 03/10/2010] [Indexed: 01/13/2023]
Affiliation(s)
- J T H Yeung
- Department of Diagnostic Radiology, Princess Margaret Hospital, Lai Chi Kok, Hong Kong.
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18
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Chitranjan, Kandpal H, Madhusudhan KS. Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve. Br J Radiol 2010; 83:e65-6. [PMID: 20197431 DOI: 10.1259/bjr/47866965] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Sciatic hernia is a rare condition with diverse clinical manifestations. We report a case of sciatic hernia causing sciatica, in which the diagnosis made on CT was subsequently confirmed on MRI including magnetic resonance neurography. The salient clinical and imaging features and a brief review are presented.
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Affiliation(s)
- Chitranjan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
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19
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Hsu HL, Huang KH, Chang CC, Liu KL. Hydronephrosis caused by ureterosciatic herniation. Urology 2010; 76:1375-6. [PMID: 20350759 DOI: 10.1016/j.urology.2009.12.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 12/07/2009] [Accepted: 12/18/2009] [Indexed: 10/19/2022]
Abstract
A 69-year-old woman with history of operation for stress urinary incontinence presented with left flank soreness. Physical examination revealed knocking tenderness at left costal-vertebral angle. Her serum creatinine level was 1.2 mg/dL and urine analysis was negative. Ultrasonography showed left hydronephrosis, and computed tomography scan revealed ureterosciatic herniation. An antegrade placement of the indwelling ureteral stent was performed. After 3 months, the double J catheter was removed and the patient recovered without recurrent symptoms.
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Affiliation(s)
- Huan-Lun Hsu
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
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20
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Losanoff JE, Basson MD, Gruber SA, Weaver DW. Sciatic hernia: a comprehensive review of the world literature (1900–2008). Am J Surg 2010; 199:52-9. [PMID: 20103066 DOI: 10.1016/j.amjsurg.2009.02.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 02/16/2009] [Accepted: 02/16/2009] [Indexed: 10/20/2022]
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21
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Abstract
Obstructive uropathy can be caused by urolithiasis, fibrotic ureteral stricture, inflammatory ureteritis with polyp formations, ureteral malignancy and various forms of external compression. Ureteral herniation is a relatively rare cause of obstructive uropathy and has been reported with herniation sites including inguinal canal, femoral canal and sciatic foramen. Most ureteral herniations occur in the inguinal area. In the literature, previous cases of sciatic ureter have been treated with observation in asymptomatic patients or with surgery in patients with obstructive uropathy or clinical symptomatology. We report the case of a 91-year-old female with asymptomatic hydronephrosis of the left kidney due to extremely rare ureterosciatic herniation. Her global renal function was acceptable. As she was elderly and a poor surgical candidate, watchful waiting was recommended after discussion with the patient and her family.
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Affiliation(s)
- Ping-Ju Tsai
- Department of Urology [corrected] Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan, ROC
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22
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Loffroy R, Bry J, Guiu B, Dubruille T, Michel F, Cercueil JP, Krausé D. Ureterosciatic hernia: a rare cause of ureteral obstruction visualized by multislice helical computed tomography. Urology 2007; 69:385.e1-3. [PMID: 17320692 DOI: 10.1016/j.urology.2006.11.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2006] [Revised: 09/03/2006] [Accepted: 11/28/2006] [Indexed: 11/16/2022]
Abstract
Ureterosciatic herniation is an extremely rare cause of ureteral obstruction, of which few cases have been published. We describe a case revealed by pyelonephritis with acute renal failure in an 81-year-old woman. After percutaneous nephrostomy tube placement and antibiotic therapy, urography and multiplanar computed tomography reconstructions of the pelvis confirmed the diagnosis. The symptoms resolved, and the hernia was then corrected surgically.
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Affiliation(s)
- Romaric Loffroy
- Department of Radiology, Bocage Hospital, University Hospital Center, Dijon, France.
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