Ureteral involvement in an inguinal hernia: the importance of preoperative identification

A ureteroinguinal hernia is a rare clinical finding, particularly in those without any previous abdominal surgery. We report the case of an 80-year-old male, with no previous abdominal surgery, who presented with a large symptomatic right-sided inguinoscrotal hernia, associated with lower urinary tract symptoms. Preoperative computed tomography demonstrated a mild-to-moderate right-sided hydronephrosis, with the distal ureter tapering and looping into the inguinal hernia. Intraoperative retrograde pyelography confirmed a characteristic 'fish hook' configuration of the distal ureter. The patient underwent an elective open right inguinal hernia repair with a preprocedural intraoperative ureteric stent placement to ensure sufficient identification, preservation, and reduction of the ureter during the operation. Postoperative imaging demonstrated sufficient straightening of the ureter and the patient had an uneventful recovery. This case highlights the importance of preoperative imaging and multidisciplinary planning in patients with inguinal hernia and ipsilateral hydronephrosis in order to prevent any inadvertent ureteric injury.