Delgado-Miguel Carlos, Muñoz-Serrano Antonio Jesus, Aguado Pablo, Fuentes Ennio, Díez Ricardo
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Department of Pediatric Surgery, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain.
European J Pediatr Surg Rep. 2024 Jan 22;12(1):e16-e19. doi: 10.1055/s-0044-1779253. eCollection 2024 Jan.
Inguinal herniation of ureter is an uncommon finding among children, with scarce reported cases in the literature to date, that can potentially lead to obstructive uropathy. We report a case of ureteroinguinal herniation discovered during an inguinal hernia repair in a patient with antenatally ultrasound finding of hydronephrosis. A 2-month-old infant with antenatal left hydronephrosis presented with left inguinal mass. Preoperative ultrasound showed an anechoic tubular image producing a mass effect on the left testicle, with suspected bladder herniation and/or dilated ureter toward the inguinal canal. An open surgical inguinal exploration was performed, where the left inguinal canal revealed a peritoneal sac and sliding of the dilated left ureter behind the sac, with a significant change in diameter, corresponding to the paraperitoneal variant of ureteroinguinal herniation. Ligation of the sac and replacement of the ureter into the retroperitoneum were performed, with improvement in the hydronephrosis observed on the ultrasound 1 month after the intervention. However, 6 months later, hydronephrosis worsening as well as the obstructive pattern observed in the diuretic renogram required removal of the stenotic ureteral segment and reimplantation of the healthy proximal segment in the bladder by open approach (Cohen's reimplantation). Follow-up ultrasound of the renal tract showed no dilatation of the upper renal tract and the renal function tests were normal. Currently, the patient is 2 years old and he remains asymptomatic. In conclusion, igns of ureteral obstruction such as hydronephrosis in patients with inguinal herniation may suggest the possibility of an ureteroinguinal hernia. Preoperative diagnostic suspicion is essential.
输尿管腹股沟疝在儿童中是一种罕见的病症，迄今为止文献报道的病例很少，它可能会导致梗阻性尿路病。我们报告一例在腹股沟疝修补术中发现的输尿管腹股沟疝病例，该患者产前超声检查发现肾积水。一名产前诊断为左肾积水的2个月大婴儿出现左侧腹股沟肿块。术前超声显示一个无回声管状图像，对左侧睾丸产生肿块效应，怀疑膀胱疝和/或输尿管向腹股沟管扩张。进行了开放性腹股沟探查，术中发现左侧腹股沟管有一个腹膜囊，扩张的左输尿管在囊后滑动，直径有明显变化，符合输尿管腹股沟疝的腹膜旁变异型。对囊进行结扎并将输尿管放回腹膜后，干预后1个月超声检查显示肾积水有所改善。然而，6个月后，肾积水加重，利尿肾图显示有梗阻模式，需要通过开放手术切除狭窄的输尿管段，并将健康的近端段重新植入膀胱（科恩再植术）。对尿路的随访超声显示上尿路无扩张，肾功能检查正常。目前，该患者2岁，仍无症状。总之，腹股沟疝患者出现肾积水等输尿管梗阻迹象可能提示输尿管腹股沟疝的可能性。术前进行诊断性怀疑至关重要。
