# Intermittent Recurrence of Ureterosciatic Hernia After Spontaneous Resolution, Complicated by Emphysematous Pyelonephritis

## TL;DR

A rare case of ureterosciatic hernia is described, where the condition spontaneously resolved and later recurred with complications, highlighting a non-surgical treatment approach.

## Contribution

The first report of spontaneous resolution and intermittent recurrence of ureterosciatic hernia with radiographic evidence and a non-surgical treatment strategy.

## Key findings

- Ureterosciatic hernia can spontaneously resolve and later recur with emphysematous pyelonephritis.
- Retrograde ureteral realignment with catheter insertion is a viable alternative to surgery in high-risk patients.
- Serial radiographic imaging confirmed the intermittent nature of the hernia.

## Abstract

Ureterosciatic hernia is a rare condition in which the ureter herniates through the sciatic foramen, causing ureteral obstruction, and urinary infection.

A 72‐year‐old woman presented with left flank pain. Computed tomography revealed left hydronephrosis with ureterosciatic hernia. During treatment planning, she developed a cerebral infarction and worsening angina, and received conservative management. One year later, computed tomography showed spontaneous resolution of the hernia. Subsequently, she experienced left flank pain, and repeat computed tomography demonstrated recurrence of the hernia with emphysematous pyelonephritis. Due to the high surgical risk, she underwent antibiotic therapy and stepwise retrograde ureteral realignment with ureteral catheter insertion, followed by double‐J stent replacement.

This is the first report to describe the spontaneous resolution and intermittent recurrence of ureterosciatic hernia on serial radiographic examinations. Retrograde ureteral realignment may be a safe and effective alternative to surgical repair in frail patients.