Authors (Year of publication)

Age/gender

Laterality

Presentation

Acute Management

Outcome of acute management

Investigations

Indication for definitive management

Definitive management

Outcome of definitive management

Swithinbank (1958)

60/F

Right

Intermittent right flank pain with radiation to pelvis

Morphine, spontaneous resolution

Pain subsidence

Intravenous pyelogram showing loop of ureter with intrathoracic route, hydronephrosis

Refractory symptoms

Surgical repair – herniation reduced, and hiatus closed

Intra- venous pyelography, showed the right ureter pursuing a more normal, sub-diaphragmatic course

Paterson and Lupton (1989)

75/M

Right

Right hypochondrial pain, nausea and vomiting

Morphine, spontaneous resolution

Pain subsidence

IVP, CT showing herniation of PUJ Renogram confirming obstruction

Refractory symptoms

Surgical repair – side to side pelviureteric anastomosis

IVP showed normal ureteric course

Chawla and Mond (1994)

56/M   

Right   

Intermittent flank pain on both sides

Pain relief

Pain subsidence

IVP, CT showing herniation but no obstruction

none

Conservative

Intermittent symptoms with spontaneous resolution

Catalano et al. (1998)           

63/F    

Right   

Upon workup for renal stones  

ESWL for stone, pain relief

Pain subsidence

IVP, CT showing abnormal course of ureter with some dilatation

To prevent obstruction with stone fragment after ESWL, and to prevent further stones

Surgical removal of renal stone, reduction of hernia and repair of the diaphragm.

No further stones, normal course of ureter

Sukumar et al. (2010)                       

75/F

Right               

Incidental finding on workup for renal failure and respiratory infection

Supportive management

Pain subsidence

CT, retrograde studies showed Curlicue sign. Prompt drainage suggesting no obstruction

None

Conservative

No report of further respiratory or renal compromise

Balakrishnan and Neerhut (2011) 

83/F    

Right   

Intermittent Right flank pain     

Retrograde ureteric stent insertion

Resolution of pain

CT showing herniation

none

6 monthly stent changes

No recurrence of pain

Song et al. (2011) 

75/M   

Right   

Right upper quadrant pain           

Retrograde ureteric stent insertion. Removal of stent

Resolution of pain and obstruction

CT showing herniation

Patient opted not to have surgery, no recurrence of hydronephrosis

conservative

No recurrence of pain or hydronephrosis

Hatzidakis et al. (2014)           

86/F                            

Right

Septic obstructive pyelonephritis

Nephrostomy followed by antegrade ureteric stenting

Relief of sepsis and obstruction

CT showing obstruction and herniation

none

Stent insertion and change

Straightening of course of ureter.

Almeida et al. (2015)                                   

82/F

Right

Incidental on PET scan for workup of lung nodule

None mentioned

None mentioned

CT showing a knuckle of ureter in chest

None mentioned

Not mentioned

None mentioned

Dru and Josephson (2016)                                     

94/F

Right

Sharp right flank pain

Cystoscopy and retrograde stent insertion

Resolution of obstruction

CT showing herniation and obstruction

None mentioned

None mentioned

None mentioned

Lin et al. (2017)                                     

81/F

Right

Right flank pain and renal obstruction

Initial conservative management, then retrograde ureteral stenting on progression of hydronephrosis and MAG3 showing obstruction

Resolution of obstruction

CT showing herniation. Mag3 showed reduced function on the right

Worsening herniation despite stent, presence of stented ureter in thorax

Surgical repair of defect, nephropexy, excision of redundant ureter and pelviureteric end-to-end anastomosis

No herniation or obstruction

Beland et al. (2019)                         

84/F

Right   

Obstructing ureteric stone in a herniated ureter

Flexile ureteroscopy and LASER fragmentation of the stone

Removal of stone, persistence of herniation

CT showed stone and ureteric herniation

None mentioned

None mentioned

None mentioned

Abou Heidar et al. (2019)

71/M

Right

Abdominal pain, vomiting and lose stools

Conservative

Improvement in symptoms

CT showing herniation

None

Conservative

None

Current case

>80/F

Right

Right sided abdominal pain

conservative

Improvement in symptoms

CT showing herniation, MAG3 showing no obstruction and normal split renal function

none

Conservative

none