Inguinoscrotal herniation of the ureter: Description of five cases.
BACKGROUND
Descent of the ureter into the inguinal canal or scrotum is rare but undoubtedly underreported. Most known cases were recognized at the time of surgery for hernia repair. We encountered five cases recently.


METHODS
We reviewed the records and CT images of five patients with inguinal hernias containing a segment of the ureter. All of our cases, like most reported cases, featured obese adult males. Our cases had different outcomes, ranging from inadvertent injury of the displaced ureter to correction of the anomaly at the time of hernia repair.


CONCLUSIONS
In all of our cases, the affected ureter was displaced anteriorly from the psoas muscle by greater than 1cm at the level of the L4 vertebra on abdominal CT. This association has not been previously described.


CONCLUSIONS
Pre-operative diagnosis by CT can prevent injury to the ureter. We hypothesize that anterior displacement of the ureter at the level of L4 as seen on CT may be predictive of inguinoscrotal herniation of the ureter.
St. Louis University School of Medicine, St. Louis, MO, United States.
Allam
A
E S
St. Louis University School of Medicine, St. Louis, MO, United States.
Johnson
J
D Y
Washington University School of Medicine in St. Louis, St. Louis, MO, United States.
Grewal
G
S G
St. Louis University School of Medicine, St. Louis, MO, United States; St. Louis Veterans Affairs Medical Center, St. Louis, MO, United States. Electronic address: frank.johnson1@va.gov.
Johnson
J
F E