Ultrasonographic diagnosis of ovary-containing hernias of the canal of Nuck

Abstract

Purpose:The purpose of this study is to describe the ultrasonographic findings of ovary-containing hernias of the canal of Nuck.Methods:This was a retrospective analysis of 22 hernia cases of the canal of Nuck. The following gray scale and color Doppler ultrasonographic features were analyzed: the site and the size of the hernia, the texture of the hernia contents, and the presence or absence of blood flow in the hernia contents.Results:All of the patients had swelling of the right inguinal region (n=10), left inguinal region (n=8), or both (n=2). On ultrasonography, the hernias appeared as either solid masses (n=17) or solid masses containing cysts (n=5). The mean anteroposterior diameter of the hernia sac of the canal of Nuck was 9.1 mm (range, 5 to 18 mm). The mean anteroposterior diameters of the hernia sac were 11.6 mm (range, 7.6 to 18 mm) for hernias containing an ovary, and 8.3 mm (range, 5 to 13 mm) for hernias containing omental fat. During surgery, among the 17 cases with solid-appearing hernia contents on ultrasonography, omental fat was identified in the hernia sac in four cases, but no structure was identified in 13 cases. All five cases that appeared as solid masses containing cysts on ultrasonography contained ovary tissue in the hernia sac. Among the four cases of ovary-containing hernias, color Doppler ultrasonography identified blood flow within the ovary in three cases, but no flow signal was seen in one case of incarcerated hernia.Conclusion:Ultrasonography may be helpful for the diagnosis of ovary-containing hernias of the canal of Nuck by detecting solid masses containing small cysts.

Ovarian torsion within an incarcereted inguinal hernia; Ultrasound and color Doppler findings

“…Furthermore, US provides detailed information about the nature of the mass and its relationship to adjacent structures. On US, the visualization of nodular masses which contain peripheral cysts is helpful for the characterization of hernia content as ovaries 1,3 .…”

“…Ovarian torsion generally presents with symptoms such as severe irritability, abdominal pain, and vomiting. Gangrene and tissue necrosis may develop if the hernia is not reduced 3 . US findings of ovarian torsion can be summarised as an increase in the ovarian dimensions with a heterogeneous echo structure (probably due to hemorrhagic necrosis), and the presence of peripherally located multiple cysts.…”

“…The incidence of indirect inguinal hernia in girls has been reported as 13,7%-23% 1,2 . In female patients, in 15% to 20% of cases there is an ovary with or without Fallopian tube in the inguinal hernia 3 . Ovarian torsion can occur within the inguinal hernia sac.…”

Canal of Nuck Abnormalities

“…Incarceration is thought to increase the risk of ovarian torsion due to blockage of the normal venous and lymphatic return from the ovary contained in the canal of Nuck . Ultrasound can establish a definite diagnosis between a canal of Nuck hydrocele, a hernia, or other labial masses in 100% of cases of labial swelling . Ultrasound is also very helpful in identifying the nature of the herniated contents.…”

Laparoscopic treatment for hydrocele of the canal of Nuck

“…The canal is said to occur when there is failure of obliteration of the peritoneal fold, as it accompanies the round ligament of the uterus, when it descends into the labium majora through the inguinal canal. This obliteration is said to occur usually by eight months of gestation [1], failure of which results in a communication with the peritoneal cavity, which can manifest as an inguinal hernia or a hydrocele.…”