Acute Extraperitoneal Herniation of Transplant Kidney Ureter Masquerading as Anuria of acute onset.

Arshad B Khan; Gulnaz Choudhary; Christina Barner; Tzvetanov Ivo

Volume : VIII, Issue : III, March - 2019

Acute Extraperitoneal Herniation of Transplant Kidney Ureter Masquerading as Anuria of acute onset.

Arshad B Khan, Gulnaz Choudhary, Christina Barner, Tzvetanov Ivo

Abstract :

Herniation of transplant kidney ureter causing obstructive uropathy is a rare, albeit known clinical entity. Most cases present insidiously and are detected during the work up of renal dysfunction. Majority of the herniations are paraperitoneal and present insidiously. Extraperitoneal herniation is a rare clinical entity with only a few cases reported in the literature. We present a case of acute extraperitoneal herniation of transplant ureter in a patient with a previous kidney transplant. The ureter herniated extraperitoneally into the inguinal canal leading to anuria and kidney dysfunction. The patient was operated up on, the hernia was reduced, and repair was effected by coopers ligament repair using mesh. The factors that could have contributed to the occurrence of such rare hernia in our patient were redundant ureter, positioning of ureter over the spermatic cord and inguinal scarring facilitating adhesions between the ureter and spermatic cord as a sequel to kidney transplantation. The patient recovered well and was discharged with a normal kidney function. Herniation of ureter should be considered in the workup of a patient presenting with acute or chronic kidney graft dysfunction with or without clinically obvious hernia as an extra–peritoneal hernia of ureter may not evict any local signs until later stages of graft dysfunction.