A rare presentation of ectopic ovary in a female adolescent and the impact of obesity: a case report

Agbor et al. Journal of Medical Case Reports A rare presentation of ectopic ovary in a female adolescent and the impact of obesity: a case report Valirie Ndip Agbor 3 Tsi Njim 2 4 Leopold Ndemnge Aminde 0 1 0 School of Public Health, Faculty of Medicine & Biomedical Sciences, University of Queensland , Brisbane, QLD 4006 , Australia 1 Clinical Research Education , Networking and Consultancy (CRENC), Douala, Littoral , Cameroon 2 Nuffield Department of Medicine, University of Oxford , Oxford, Oxfordshire , UK 3 Hope Clinic Bamenda , Bamenda, North-West Region , Cameroon 4 Health and Human Development (2HD) Research Group , Douala , Cameroon Background: Inguinal hernias in women of reproductive age containing the ovary are very rare. When they occur in this age group, they are mostly associated with malformations of the urogenital system. Prompt surgical intervention is the key to ensure survival of the ovary. Here we present a case of an ectopic ovary presenting like an acute appendicitis. Case presentation: A 16-year-old Cameroonian girl presented at our emergency service with an acute exacerbation of a mild and intermittent right iliac fossa pain of 5 days' duration. A clinical examination revealed android obesity and signs suggestive of an acute appendicitis. An abdominopelvic ultrasound scan showed an edematous right ovary in the canal of Nuck. A prompt hernia repair was done and her postoperative period was uneventful. Conclusions: An ectopic inguinal ovary remains a rare occurrence. An urgent and careful exploration of the hernia sac is the standard of care. Careful physical examination of obese girls and women is vital particularly in emergency settings, as obesity in our patient contributed greatly to a missed diagnosis. Clinicians should potentially consider the possibility of an ectopic ovary when faced with girls and women presenting with right iliac fossa pain. Ectopic ovary; Inguinal hernia; Obesity; Cameroon - Background Inguinal hernias occur in less than 5 % of women. These hernias usually contain a variety of viscera, commonly the intestines and omentum. An inguinal hernia containing the ovary is very rare in women of reproductive age. Only 3 % of cases of inguinal hernias contain viscera such as female adnexa [1], 30 % of which occur in adolescents or women of reproductive age [2]. In most cases, the diagnosis of a hernia is clinical; however, an ultrasound scan is helpful in uncertain circumstances. Inguinal hernias can present either as asymptomatic progressive groin swellings or acutely, with associated mild to severe abdominopelvic pain [3]. We report the case of a 16-year-old girl with an incarcerated right ovarian inguinal hernia presenting like acute appendicitis. Case presentation A 16-year-old Cameroonian girl presented to our emergency service with an acute exacerbation of a mild and intermittent right iliac fossa (RIF) pain of 5 days’ duration associated with anorexia and nausea. Her last menstrual period was 2 weeks prior to consultation. Her menarche was at the age of 12 years and she had a menstrual flow of 3 to 4 days with a regular cycle of 28 to 30 days. She was neither sexually active nor had a history of dysmenorrhea, and the rest of her past history was unremarkable. There was no vomiting, obstipation, fever, abnormal vaginal discharges, or urinary tract symptoms. On clinical examination, she was anxious with pain quoted 6/ 10 according to the visual analog pain scale, tachycardic (pulse rate of 110 beats per minute), and afebrile (maximum temperature of 36.8 °C). Her body mass index (BMI) was 34.2 kg/m2 and waist circumference 101 cm. She had tenderness at the McBurney’s point, and positive Bloomberg, obturator, and psoas signs. The clinical presentation suggested a presumptive diagnosis of acute appendicitis. © 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. A complete blood count (CBC) with differentials, Creactive protein (CRP), and a urine analysis were normal, and her pregnancy test was negative. An abdominopelvic ultrasound scan revealed an edematous right ovary measuring 5.7×2.1×4.5 cm, in the canal of Nuck (clearly visible in real-time motion; Fig. 1). We therefore concluded on the diagnosis of an incarcerated right inguinal hernia of the ovary. An urgent gynecological review was made and she was immediately prepared for surgery. The timeframe from diagnosis to surgery was approximately 2 hours and 30 mi (...truncated)