Laparoscopic Repair of a Ureteric Sciatic Hernia: Report of a Case

Ureteric sciatic hernias are extremely rare. Here we report a case of a 78-year-old woman presented with colicky left abdominal pain. Computed tomography revealed a ureteric sciatic hernia, and drip infusion pyelography revealed dilated left ureter with herniation of the ureter into the sciatic foramen. The hernia was successfully repaired laparoscopically. We have described the diagnosis and management of the patient, followed by a review of the literature on sciatic hernias. 1. Introduction In general, sciatic hernias are very rare with very limited literature worldwide [1]. Of all sciatic hernias, ureteric sciatic hernia is extremely rare. To the best of our knowledge, there have been only approximately 25 cases of ureteric sciatic hernias previously reported [1–5]. Successful laparoscopic management of ureteric sciatic hernia has been described for only three patients [2–4]. Here we report the fourth case of a laparoscopically repaired ureteric sciatic hernia. 2. Case Report A 78-year-old Japanese woman presented to our hospital because of colicky left abdominal pain. She had no history of any hip or neuromuscular disease. Her past medical history was only a Cesarean section. Physical examination revealed her height as 155？cm and weight as 35？kg (body mass index 14.5), and she was afebrile and in good general health. Blood examination and urinalysis was normal. She complained of left costovertebral angle tenderness. Computed tomography (CT) revealed dilated left ureter with herniation of the ureter into the sciatic foramen (Figure 1). Drip infusion pyelography (DIP) identified that the left ureter was dilated and ran an unusual and convoluted course laterally through the pelvis (Figure 2). We diagnosed her case as left ureteric sciatic hernia on the basis of these findings. Figure 1: Computed tomography showed ureteral herniation into the sciatic foramen (arrow). Figure 2: Drip infusion pyelography revealed “curlicue ureter” sign as the knuckle of the herniated ureter passed laterally to the medial wall of the bony pelvis (arrows). The patient’s symptoms spontaneously are resolved before long. We followed up her closely without treatment for four months. However, the patient’s symptoms recurred occasionally, and the left hydroureter remained unchanged. We decided to laparoscopically repair the hernia. Operative Management. The patient was positioned in a head-down right semilateral position after general anesthesia. A balloon trocar was placed superior to the umbilicus. Three accessory ports (5？mm) were placed under direct laparoscopic control, and