Ureteric sciatic herniation

Case contributed by Dr Craig Hacking

Presentation

Sudden onset right sided abdominal pain and vomiting.

Patient Data

Age: 80
Gender: Female
CT

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 calibre 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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Case information

rID: 35477
Case created: 8th Apr 2015
Last edited: 23rd Jun 2017
System: Urogenital
Inclusion in quiz mode: Included

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