many organs can be herniated into the scrotum such as small intestine , appendix , colon , and ovaries .
ureteral herniation is extremely rare , usually asymptomatic and is reported as isolated case report or small series .
we report the case of an 88-year - old man treated for inguinoscrotal hernia where the left ureter was incidentally found in the herniated retroperitoneal fat . presenting symptoms , diagnostic evaluation , and surgical management
an 88-year - old man was admitted for a left moderately sized inguinoscrotal hernia . his medical history included hypertension and benign prostatic hyperplasia .
the herniated parts were dislocated from the scrotum , as well as the testicle , and cord strictures .
the cord was separated from the herniated parts and was partially covered from preperitoneal fat .
a large amount of retroperitoneal fat surrounded from a sac - like formation was found adjacent to the cordis [ figure 1a and b ] .
these adhesions , as well as a part of this fat , were excised because of the irreducibility of the mass . during the excision ,
24 h later , an abdominal ultrasound was performed to rule out any structural abnormality , which may have been missed preoperatively .
( a and b ) the left extraperitoneal inguinoscrotal hernia the ureter identified into the herniated retroperitoneal fat
ureteral herniation is rare , and approximately 140 cases have been reported in the literature , mainly as isolated case reports or small series .
ureteric hernia is also reported as spontaneous , postoperative or as a complication of renal transplantation .
ureteral herniation presents as a groin mass usually asymptomatic although many cases describe association with dysuria , hematuria , and hydronephrosis .
the hernia has the classical aspect of an indirect hernia ; it is formed by the sac anteromedially that contain viscera that make up the wall of the sac , and the ureter lying posterolaterally .
the ureter slides into the canal drawn by the posterior peritoneum that follows the herniated viscera .
paraperitoneal hernias are more common in men , usually located on the right side , are often large in size , usually reducible and rarely symptomatic .
there is not a clear association with kidney or ureteric abnormalities . on the other hand ,
the hernia is often accompanied by the large amount of retroperitoneal fat , is often nonreducible , usually small and commonly associated with urinary symptoms .
authors consider this type of hernia congenital and related to developmental abnormalities of differentiation of the ureter from the wolffian duct .
the ureter slides along with the testis into the scrotum ; a process also favored by adhesions between the ureter and genitoinguinal ligaments .
many extraperitoneal hernias have a congenital association to renal or ureteral malformation such as crossed renal ectopia or nephroptosis .
however , in our case the hernia was sizable , partially reducible and was no associated with urinary symptoms .
the diagnosis of ureteral hernia is often missed due to lack of urinary symptoms or signs or symptoms that could lead doctors to apply an extended preoperative work up .
although computed tomography may determine the type and the contents of hernias and the intravenous urography may determine abnormalities before surgery , they are not justifiable on every inguinal hernia repair .
considering the fact that ureteric injuries are serious complications and require additional surgical approaches , we emphasize the high index of suspicion needed by surgeons when repairing hernias identifying gross amount of sliding fat and resecting fat trying to reduce hernia into the abdomen .
 an inguinoscrotal hernia is a common disorder that usually contains intraperitoneal organs ( small intestine , colon , appendix , ovaries ) . 
 extraperitoneal ureteral herniation into an inguinoscrotal hernia is a rare condition and often associated with congenital abnormalities or postoperative anatomic changes . 
 a high index of suspicion is needed in order to avoid intraoperative ureteric injuries . 
 we herein report the case of a ureteric herniation into an inguinoscrotal hernia incidentally found during a scheduled hernia repair . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION
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