Successful manual reduction for ureterosciatic hernia: A cas
Sciatic hernias are the least common type of pelvic floor hernias. The purpose of this study was to present a novel technique for manual reduction and to conduct a systematic review of previous reports of sciatic hernias to characterize them and review the outcomes.

An 86-year-old female presented with left-sided lumbar pain. She had a past medical history of rheumatoid arthritis and was treated with prednisolone and methotrexate. On physical examination, her left abdomen and left lumbar area were tender. Laboratory examination showed no abnormalities. An unenhanced abdominal computed tomography (CT) scan revealed invagination of the left ureter into the left sciatic foramen and a dilated left proximal ureter and renal pelvis. Ultrasonography showed an invaginated left ureter when the probe was placed on the left buttock. The hernia orifice was 10 mm in diameter.

She was diagnosed with a sciatic hernia. On the second hospital day, her symptoms continued and ultrasound-guided manual transvaginal reduction was performed. The patient was placed in the prone position in bed. The entire hand of the examiner was inserted into the vagina. Tension was put on the ureter along with nearby retroperitoneal tissue by the right index and middle finger of the examiner. The ultrasound probe was placed on the left buttock of the patient. The invaginated ureter was then reduced. Post-procedure unenhanced abdominal CT scan confirmed reduction of the ureter. The post-reduction clinical course was uneventful, and she was discharged one day after the procedure. After 10-months of follow-up, there is no evidence of recurrence.

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