腹腔鏡下膀胱尿管新吻合術で治療した尿管坐骨孔ヘルニアの1例

Abstract

Pelvic herniation of the ureter through anatomical musculoskeletal foramina stands out as one of the rarest causes of ureteric obstruction. The herniation of the ureter through the sciatic foramen presents as a particularly uncommon variant of this condition. A 62-year-old woman was referred to our hospital from a family practioner with symptoms of fever and septic shock. Subsequent computed tomography imaging revealed left hydroureteronephrosis without clear evidence of ureteral stones or ureteral tumors and that the lower part of the ureter was shifted to the outside of the cavum pelvis minor from the greater sciatic foramen. She was diagnosed with ureterosciatic hernia, and a left retrograde ureteral stent was indwelled. Her hemodynamic status improved and the ureteral stent was removed after ureteral migration became normal. However, three months later, left ureterosciatic hernia recurred. Therefore, we performed laparoscopic vesicoureteral neoanastomosis and native tissue repair of hernia by uterine appendages. The postoperative course was uneventful. We believe this is a durable repair although longer follow-up is needed to establish the longevity of our treatment modality.