Bochdalek foramen ureteral diaphragmatic hernia is rare, and concurrent hiatal hernia is unreported. We retrospectively analyzed a 79-year-old female with right lumbago-abdominal pain, diagnosed via CTU with right Bochdalek ureteral hernia-induced severe hydronephrosis and incidental left hiatal hernia. Transurethral ureteral stenting with flexible ureteroscopy relieved symptoms immediately and normalized renal function. Hierarchical care refers to a tiered medical system where patients are initially evaluated at primary hospitals and referred to higher-level centers for complex diagnosis and treatment. This case highlights distinguishing pathogenic from concurrent hernias and the value of hierarchical care. • 1.This is the first reported case of concurrent right Bochdalek foramen ureteral diaphragmatic hernia and incidentally detected left hiatal hernia in an adult, which enriches the clinical spectrum of rare diaphragmatic hernia combinations. • 2.Computed tomography urography is confirmed as the gold standard for accurate diagnosis of this rare disease, enabling clear differentiation between pathogenic and asymptomatic hernias. • 3.Flexible ureteroscopy-assisted double-J stent placement is verified as an optimal minimally invasive treatment for elderly patients with poor surgical tolerance, achieving immediate symptom relief and renal function recovery. • 4.The case highlights the critical role of hierarchical diagnosis and treatment system in managing rare diseases, ensuring timely and standardized treatment for patients from primary hospitals.
Qi et al. (Sun,) studied this question.