Giant megaureter presenting as femoral hernia: case report

A mega ureter is an abnormally dilated ureter. It is one of the common ureteral anomalies. It manifests in various forms, ranging from incidental findings to obstructive uropathy. A megaureter herniating through the femoral canal is unreported. If the diagnosis is missed, the herniated ureter can be inadvertently injured. Management of a megaureter depends on the clinical condition of the patient.

A 30-year-old female patient presented with progressive abdominal swelling, which extended to the left mid-thigh. She was operated on and found to have a hugely dilated ureter, which is herniated through the femoral canal, and she underwent a left ureteronephrectomy since the kidney was an atrophied, hydronephrotic kidney.

A megaureter is a common ureteral anomaly caused by different mechanisms. It is usually asymptomatic, but can present as recurrent urinary tract infection, abdominal pain and flank pain. Rarely present as abdominal/flank pain and urinary incontinence. Presentation as an inguinal hernia is extremely rare, and a megaureter herniating through the femoral canal is not reported in the English literature. Diagnosis of mega ureter involves clinical evaluation and radiologic imaging. Its management depends on the type of mega ureter, clinical condition of the patient and renal status.

Even though it is rare, a herniated ureter should be considered in the differential diagnosis of an irreducible inguinal mass. Diagnosis can be established through imaging such as ultrasonography or CT urography. Early recognition is crucial, as careful surgical repair with identification and preservation of the ureter prevents inadvertent injury and preserves renal function.