A 68-year-old man presented with progressive as-cites and left flank pain that had developed during the last several weeks. Laboratory results indicated an elevated creatinine level of 2.33 mg/dL. Medical history included end stage liver disease, for which he had undergone a transjugular intrahepatic portal system shunt (TIPS) placement 5 years earlier. After the patient was hospitalized the shunt was found to be occluded. Recanalization was attempted but was not successful. Noncontrast computerized tomography (CT) of the abdomen and pelvis demonstrated left hydronephrosis with retained intravenous contrast from the hepatic venogram, and obstruction of the ureter within a large ipsi-lateral indirect inguinal hernia (fig. 1).
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