Presentation
Sudden onset right sided abdominal pain and vomiting.
Patient Data
Severe hydronephrosis of the malrotated right kidney with a large amount of right perinephric fluid which is the same density as urine indicating acute rupture of the collecting system. Subsequent delayed enhancement of the right kidney. Severe right ureteric dilatation to the level of the right greater sciatic foramen where the ureter herniates laterally out of the pelvis and an abrupt ureteric caliber change is seen. The distal ureter beyond the herniation is collapsed to the level of the VUJ. No calculus identified.
Incidental findings include:
- baggy extra renal pelvis on the left
- atrophic uterus with calcified fibroids
- colonic diverticulosis
- prominence of the intra and extra hepatic ducts following cholecystectomy (which is longstanding)
- duodenal diverticulum
- calcified liver granuloma
- calcified pelvic sidewall lymph nodes
- aortic calcified atheroma
- lung basal fibrosis,
- coronary artery and valvular calcification
- degenerative lumbar spine and right hip
Case Discussion
Surgery confirmed herniation of the distal ureter laterally through a small tight fascial defect at the lower margin of the great sciatic foramen, just above the ischial spine. The ureter was reduced and the fascial defect closed.
The ARF then resolved.
Ureteric herniation is rare!
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