Undiagnosed ureteroinguinal hernia with solitary kidney in a child with ureteric injury during herniotomy Abahilasha Tej Handu, Saurabh Garge, Nitin J. Peters, Ravi Prakash Kanojia ⁎ , K.L.N. Rao Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India Received 18 October 2011; revised 4 January 2012; accepted 4 January 2012 Key words: Ureteroinguinal hernia; Ureter injury; Ureter substitution; Hernia inguinal; Vermiform appendix Abstract Iatrogenic ureteric injuries are an uncommon but difficult problem to manage. Although ureteric injury has been reported during hernia surgery in adults, it has not been reported in children during herniotomy. An 18-month-old male child underwent repair of an inguinal hernia and developed postoperative anuria. Investigations revealed that the patient had a solitary kidney and had injury to the solitary ureter. We successfully managed this patient using the vermiform appendix to replace a segment of the injured ureter. The possible mechanism of injury and the relevant literature are discussed. © 2012 Elsevier Inc. All rights reserved. Ureteric injuries in the pediatric age group are rare as compared with adults. They are a source of significant morbidity, especially if not recognized immediately, and may require special techniques for restoration of ureteric continuity [1]. We describe a child with undiagnosed ureteroinguinal hernia and a solitary kidney who had iatrogenic ureteric injury during herniotomy. The injury to the solitary ureter was managed by interposition with appendix. Iatrogenic injury to the ureter during herniotomy has not been previously reported in children. 1. Case history A one-and-a-half-year-old male child was referred with anuria after herniotomy performed elsewhere. The child had deranged renal function (blood urea nitrogen, 76 mg, and serum creatinine, 3.9). A renal ultrasound showed right hydronephrosis with no ureteral dilation and a nonvisualized left kidney. The patient initially underwent peritoneal dialysis. A repeat ultrasound examination showed increasing dilatation of the right renal pelvis and upper ureter. A percutaneous right nephrostomy was performed. The renal functions normalized after nephrost- omy drainage. An ethylene dicysteine diuretic renal scan showed a hydronephrotic right kidney with preserved cortical function and obstructed drainage and a nonvisua- lized left kidney. A nephrostogram showed a dilated pelvicalyceal system and upper ureter with contrast extravasation at the midureteric level and nonopacification of the bladder. Cystoscopy was done in an effort to perform a retrograde study and possibly pass a double J stent across the obstructed ureter. Although both ureteric orifices were seen in their normal locations, it was not possible to pass the guide wire beyond 2 cm from the ureteric orifice. Open exploration was undertaken, and the upper ureter was found to be dilated. The midureter was ⁎ Corresponding author. Block 3A Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12 Chandigarh, Pin 160012, India. E-mail address: drravikanojia@yahoo.com (R.P. Kanojia). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2012.01.006 Journal of Pediatric Surgery (2012) 47, 799–802