Remarkable Case of a Right Renal Flank Hernia
James Kovacic, Stephen Ruthven

Central Coast Local Health District, Urology, Gosford, Australia

A 95-year-old female presented to hospital with a 
3-day history of worsening right-sided flank pain, on 
background of recent heavy lifting. The pain was dull 
in nature and centred over a bulge at her right flank. 
It was not associated with any subjective fevers, bowel 
disturbance, or urinar y sy mptoms. Examination 
identif ied an uncomfor table but haemody nica lly 
normal patient. Abdominal examination revealed a 
soft abdomen with a tender, palpable mass over the 
right flank in line with a surgical scar. The mass was 
reducible but would spontaneously re-herniate on 
cessation of pressure.

The patient had a significant history of a right-
sided minima lly invasive latera l transpsoas L1-5 
spinal fusion (also known as a direct lateral inter-
body fusion [DLIF]) 6-years earlier. Other significant 
history included atrial fibrillation on anticoagulation, 
cerebrovascular attack on aspirin, breast cancer, and 
recurrent urinary tract infections. She lived at home 
independently.

Biochemistr y and inf lammator y markers were 
norma l. CT imaging demonstrated a right rena l 
flank hernia through the retroperitoneum into the 
subcutaeneous tissue (Figures 1A and 1B). The renal 
artery and vein were significantly stretched, without 
evidence of acute pathology. There was no evidence of 
hydronephrosis or delayed nephrogram.

T he  p at ient  w a s  mon itore d  over n i g ht  a nd 
discharged on simple a na lgesia. Af ter fol low-up 
discussion with the patient, and given her age and 
comorbidities, the decision at this stage has been to 
take a conservative approach with use of a body vest 
to keep the kidney within the retroperitoneum.

This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited.  
© 2022 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

Key Words Competing Interests Article Information

Hernia, retroperitoneal, flank Conflict of Interest: None declared.

Patient Consent: Obtained.

Received on October 14, 2021 
Accepted on October 17, 2021

Soc Int Urol J.2022;3(2):111

DOI: 10.48083/YERA5234

FIGURE 1A. 

Axial CT 

FIGURE 1B. 

Sagittal CT 

111SIUJ.ORG SIUJ  •  Volume 3, Number 2  •  March 2022

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