Ruptured Renal Pelvis Due to Obstruction by Ureterosciatic Hernia: A Rare Condition With a Rare Complication

Ureterosciatic Hernia in Focus: A Narrative Review of the Literature

Pelvic herniation of the ureter through anatomical musculoskeletal foramina stands out as one of the rarest causes of ureteric obstruction. Historically, most cases have been documented as incidental intraoperative findings. The herniation of the ureter through the sciatic foramen presents as a particularly uncommon variant of this condition, distinguished by its potential to cause life-threatening sepsis or renal failure if not promptly recognized and treated. The diagnostic process remains challenging, attributed partly to the vague initial symptomatology and subtle radiological findings, and second, to the rarity of this condition. This challenge may be further compounded by the lack of a clear description of clinical features and pathways to raise clinician suspicion. In light of these considerations, we conducted this literature review to illuminate this unique cause of obstructive uropathy, aiming to delineate its clinical features and explore common diagnostic and treatment options.

Urosepsis secondary to ureterosciatic hernia corrected with ureteral stent placement: a case report and literature review

BACKGROUND

Ureterosciatic hernia is a rare type of pelvic floor herniation that occurs through the sciatic foramen. The resulting ureteral obstruction may lead to hydronephrosis and to further complications including urinary tract infection and urosepsis. There have been 30 reported cases of ureterosciatic hernia. Ureteral stenting and surgical repair have been used as treatment options.

CASE PRESENTATION

We report the case of an 86-year-old woman who was transferred to Tokyo Metropolitan Bokutoh Hospital with symptoms of fever and septic shock. Her computed tomography scan revealed left hydronephrosis and deviation of the left ureter into the sciatic foramen; she was therefore diagnosed with a left ureteral sciatic hernia and admitted in our intensive care unit for further treatment with resuscitative fluids, vasopressors, and antibiotics. Following a retrograde insertion ureteral catheter insertion, ureteral incarceration was relieved, and a double-J ureteral stent was placed in situ. Antibiotic treatment was initiated, and the patient's hemodynamic status gradually improved.

CONCLUSIONS

Although ureterosciatic hernia is a rare disorder, it is associated with serious complications including urinary tract infection with sepsis, which may warrant urgent corrective procedure to relieve the structural obstruction. Treatment may be conservative or surgical, though treatment with ureteral stent placement may be a favorable approach in elderly patients with multiple comorbidities presenting with urosepsis.

Laparoscopic Repair of Ureteral Diverticulum Caused by Ureterosciatic Hernia

Ureterosciatic hernia and ureteral diverticulum are rare conditions. Only a few cases with surgical management for these conditions have been reported. We report a case of ureteral diverticulum due to ureterosciatic hernia in an 85-year-old woman admitted for septic shock. Computed tomography and retrograde ureterography revealed obstructive ureterosciatic hernia. During intraoperative laparoscopic mesh repair for the hernia after urosepsis treatment, we noted ureteral diverticulum that was also detected endoscopically at the herniated ureter wall. Suture plication was performed to prevent stricture and hernia mesh infection. To our knowledge, this is the first report on ureteral diverticulum due to ureterosciatic hernia.