A right sliding indirect inguinal hernia containing paraovarian cyst, fallopian tube, and ovary: a case report

Abstract

Albeit very uncommon, the hernia sac may contain unusual structures such as vermiform appendix, acute appendicitis, ovary, fallopian tube and, urinary bladder. Most of the cases of hernia containing ovary and fallopian tubes were reported to be found in children and, often accompanied with other congenital anomalies of genital tract. We present the first case of sliding inguinal hernia containing right ovary and fallopian tube and a right paraovarian cyst in 80-year-old, multiparous patient without any associated genital anomaly. The hernia was repaired with plication darn, while the paraovarian cyst was excised and adnexa were preserved. It is of utmost importance to keep in mind that the hernia sac may contain almost any abdominal organ, and surgical dissection should be carried out accordingly. Pathophysiologically, the ovary might be simply pulled along with a sliding paraovarian cyst or the paraovarian cyst might be accompanying the maldescended ovary. There seems to be a need for clinical and experimental studies to further explain the mechanisms that apply to the pathogenesis of sliding inguinal hernias.

What is inside the hernia sac?

“…Furthermore, as these tissues have hormonal receptors, they are under the influence of several hormonal stimuli during a woman's life, from embryogenesis to parity, and even to the effects of systemic disease in intra-abdominal pressure. 3 Our patient underwent two types of imaging diagnosis (US and CT), and yet the diagnosis was only confirmed intraoperatively. This case comes as a reminder that attention must be at highest when performing surgical dissection.…”

“…[2][3][4] Unlike men, female inguinal canal contains only the round ligament and vessels that run to the labia majora, providing a path to the development of inguinal hernias.…”

“…3 In premenopausal women, a rapid diagnosis and the prompt correction is crucial in order to save the adnexa from torsion and infarction and, therefore, ensure fertility. 5 In postmenopausal women it has been hypothesised that the progressive weakness of the ligaments of the adnexa may add to the process of herniation.…”

Female Inguinal Hernia – Conservatively Treated as Labial Swelling for a Long Time-A Case Report

“…Sliding inguinal hernia may contain the ovary, part of the uterus, fallopian tube. 7,8 Therefore the hernia sac in a female patient is like a magic box, the truth of which is revealed only after exploration. In this case, content of the sac was omentum.…”

Inguinal hernia in females: do we know enough?

“…7 A part of the uterus, fallopian tube and ovaries can also find its way in to the hernia sac. 8,9 Therefore the hernia sac in a female patents in like a magic box the truth of which is unravelled only after exploration.…”