Hernia Causing Ureteral Obstruction With Hydronephrosis and Subsequent Urinary Tract Infection and Sepsis

Inguinal hernias are common anatomic defects, especially among men. Complications of inguinal hernias include incarceration, but incarcerated hernias rarely cause other disturbances. An 86-year-old man with a history of chronic kidney disease (stage IIIb) presented with recurrent urinary tract infections and acute kidney injury with sepsis. Physical examination revealed a right inguinal hernia, and non-contrast abdominal computed tomography revealed right ureteral obstruction and distal entrapment by the inguinal hernia, with hydronephrosis. The patient underwent right retrograde pyelography and ureteral stent placement, followed by laparoscopic inguinal herniorrhaphy with mesh, which restored renal function. Our case is unique among obstructive uropathies due to inguinal hernias because the distal ureter was entrapped within the bowel mesentery communicating between the peritoneal cavity and retroperitoneum. Both inguinal hernias and obstructive uropathy are common among elderly men. While the latter is often secondary to prostate malfunction, other causes of obstructive uropathy or hydronephrosis should be considered, especially if unilateral.