Elsevier

Transplantation Proceedings

Volume 49, Issue 7, September 2017, Pages 1593-1595
Transplantation Proceedings

Original Works: Case Reports
Kidney
Inguinal Bladder Hernia With Acute Ureteral Obstruction 14 Years After Kidney Transplantation: A Case Report

https://doi.org/10.1016/j.transproceed.2017.04.003Get rights and content

Highlights

  • Herniation of the urinary bladder is a known complication of inguinal hernias.

  • Rare transplant ureter herniation is known, and risk factors have been described.

  • Ureteroneocystostomy herniation presents with acute post-renal failure.

  • Anterograde decompression and stenting facilitates retrograde stenting.

  • Retrograde stenting facilitates intraoperative recognition and reduction.

Abstract

An 82-year-old man with a history of renal transplantation 14 years earlier presented with acute obstructive renal failure secondary to inguinal herniation of the urinary bladder complicated by ureteroneocystostomy entrapment. After percutaneous nephrostomy tube and endoscopic stent placement, the bladder was reduced and the hernia repaired with the use of a preperitoneal mesh. The postoperative course was uneventful and the renal function returned to normal. Inguinal herniation of the transplant ureter is a rare cause of hydronephrosis, but it has been described in the literature. Bladder hernias do usually not cause urologic complications in the nontransplanted patient, but they can present as an emergency after renal transplantation.

Section snippets

Case Report

An 82-year-old male inpatient was evaluated for acutely worsening renal function and oliguria 7 days after aortomesenteric venous bypass. His past medical history was significant for diffuse obliterative arterial disease, atrial fibrillation, arterial hypertension, and type 2 diabetes complicated by end-stage renal disease. He had undergone a deceased-donor kidney transplantation in the left iliac fossa 14 years earlier. Body mass index was 30.1 kg/m2 at the time of transplantation and 20 kg/m2

Discussion

Concomitant herniation of the urinary bladder including the ureteroneocystostomy as described in this case is rare and has been reported only 4 times [4], [9]. Our patient presented 2 of the risk factors described above: He was overweight at the time of transplantation and had undergone multiple abdominal and inguinal vascular procedures in the past. The position of the graft ureter in relation to the spermatic cord was not mentioned in the operative report. In our institution, the ureter is

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