Rarity in conspicuity—Ultrasound diagnosis of sliding left inguinal hernia through canal of Nuck with uterus, fallopian tubes and ovaries

Abstract

We present a case of a one month old female infant who presented with left inguinal swelling. She was prematurely born at 32 weeks of gestational age. Preoperative ultrasound showed features of sliding indirect inguinal hernia with both ovaries, fallopian tubes and uterus; which were also evident per operatively. Patient underwent successful hernia repair and uneventful post-operative period. Patient is on follow up currently. In conclusion, we attempt to highlight the exiguous prevalence of inguinal hernia with uterus, fallopian tubes and ovaries; which has been sparsely reported in the literature and also the importance of preoperative of sonography.

Pathologies of the canal of Nuck

“…The canal of Nuck is relatively small compared to its male counterpart and should become obliterated by eight months gestation although patency may persist into postnatal life. The male processus vaginalis remains open until testicular descent postnatally . When the canal of Nuck fails to close the potential for herniation exists and a variety of pathologies can occur.…”

“…The differential diagnoses include canal of Nuck pathology, enlarged lymph nodes, lipoma, leiomyoma, abscess, lymphangioma or rhabdomyosarcoma. Ultrasound can play a significant role in differentiating between these genital masses . When the mass is established to be in the canal of Nuck, ultrasound can help determine the contents, which can include free or encysted fluid, omental fat, bowel loops, an ovary and in the rarest of cases uterus, fallopian tubes, broad ligament and bladder .…”

“…Ultrasound can play a significant role in differentiating between these genital masses . When the mass is established to be in the canal of Nuck, ultrasound can help determine the contents, which can include free or encysted fluid, omental fat, bowel loops, an ovary and in the rarest of cases uterus, fallopian tubes, broad ligament and bladder . Pathologies of the canal of Nuck can be divided into two categories, hydroceles of the canal of Nuck involving fluid and congenital inguinal hernias involving the prolapsing of abdominal contents through the abdominal wall.…”

“…Aspiration of these hydroceles has proven to be unsuccessful due to fluid reaccumulating. Congenital inguinal hernias will require hernioplasty including high ligation of the hernial sac and ovariopexy where the ovaries are involved …”

“…They are defined as congenital as they are due to delayed closure of a normally occurring orifice as distinct from a weakness in the abdominal wall, found in acquired inguinal hernias. Congenital inguinal hernias are uncommon in females, with males presenting six times more frequently . Prematurity increases the risk in both sexes.…”