title: Femoral herniation of transplanted ureter after deceased-donor kidney transplantation.
abstract: BACKGROUND
  Herniation of the ureter after kidney transplant is a rare and under documented event. Many of these herniations are due to abdominal wall defects or ureteral redundancy. After an extensive review of available literature, there has not been a reported case of a femoral herniation of ureter after kidney transplant. We report a case of late allograft renal transplant failure due to ureteral obstruction secondary to femoral herniation of the ureter.
  
  
  METHODS
  We report a case of 64 year old male with a history of kidney transplant, who was found to have an inguinal bulge. He was diagnosed with a femoral hernia containing transplant ureter using transplant kidney ultrasound and CT of the abdomen and pelvis. Subsequently he developed transplant kidney failure due to obstructive uropathy from the femoral hernia. The patient underwent a femoral hernia repair with biologic mesh. Compromised ureter was excised and a neoureterocystostomy was created. Post operatively his creatinine returned to baseline.
  
  
  CONCLUSIONS
  In our literature search there are two types of inguinal ureteral hernias described. Paraperitoneal, which makes up the majority of the cases, and extraperitoneal. There are no classifications for ureteral femoral hernias. We may extract these definitions to femoral hernias, as evidenced by our case where we encountered a paraperitoneal femoral hernia containing transplant kidney ureter.
  
  
  CONCLUSIONS
  To the best of our knowledge this is the first reported case of a femoral ureter hernia. Due to its rarity in the literature, an understanding of management is critical to patient outcome.
authors.affiliation: Department of Surgery, Rowan University School of Osteopathic Medicine, Stratford NJ. Our Lady of Lourdes Medical Center, Camden NJ, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Esposito
authors.affiliation: Department of Surgery, Rowan University School of Osteopathic Medicine, Stratford NJ. Our Lady of Lourdes Medical Center, Camden NJ, USA.
authors.forename: Ashanthi
authors.initials: A
authors.lastname: Ratnasekera
authors.affiliation: Department of Surgery, Rowan University School of Osteopathic Medicine, Stratford NJ. Our Lady of Lourdes Medical Center, Camden NJ, USA.
authors.forename: Ely
authors.initials: E
authors.lastname: Sebastian
authors.affiliation: Department of Surgery, Rowan University School of Osteopathic Medicine, Stratford NJ. Our Lady of Lourdes Medical Center, Camden NJ, USA.
authors.forename: Nasser
authors.initials: N
authors.lastname: Youssef
keywords: Femoral hernia; Transplant kidney; Ureteral obstruction
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