Kasık fıtığı içerisine girmiş bir Over ve Fallop tüpleri olgusu
J Surg Arts (Cer San D)
AN UNUSUAL CASE OF OVARY AND FALLOPIAN TUBE IN INGUINAL HERNIA Kas?k f?t??? i?erisine girmi? bir Over ve Fallop t?pleri olgusu
Jishnu Sankar Ray Basunia
Mahesh Yogesh Borikar
North Bengal Medical College / India
Corresponding address: Dr. Dwaipayan Samaddar
Inguinal hernia is extremely rare among girls. The hernia sac may sometimes involve intestinal structures, but ovaries in the sac are uncommon. Early diagnosis and surgery is essential to obviate the possibility of ovarian torsion. We encountered a 13 year old girl with a nonreducible groin lump that had no expansile cough impulse. An index of suspicion followed by imaging and diagnostic laparoscopy clinched the diagnosis of hernia ovary inguinale that was confirmed on exploration followed by replacement of the ovary into the pelvis. Though there might not be the usual criteria of reducibility and expansile cough impulse of hernia, we should be wary of this rare presentation especially in a young girl as it is exposed to the risk of torsion that we can prevent by early surgery.
Inguinal hernia; reduction; ovary; and fallopian tube
The most common etiology of inguinal
swellings in children is inguinal hernia, with an
incidence ranging from 0.8% to 4% (
infants, inguinal hernias are found about six times
more commonly in male than in female (
These are right sided in nearly 60% cases, left
sided in 30% and bilateral in 10% cases (
Inguinal hernia in the adolescent is generally not
due to any defect in the posterior wall of the
inguinal canal but it is generally due to a
persistent processus vaginalis (
). Hernia of an
ovary is rare and 95% of ovarian hernias are
). Here we present a rare case of
uncomplicated hernia ovary inguinale presenting
with a mobile irreducible groin swelling without
an expansile cough impulse in adolescence.
A 13 year old girl presented with a
swelling in the right groin since birth. Initially
the swelling was pea sized and progressively
increasing without any recent history of rapid
growth. The size neither changed with position
nor with any act that increased the
intraabdominal pressure. The swelling was painless all
through its course. The girl had no other complaint
and there was no significant past history. Her
mother had no significant history of any drug intake
or illness during pregnancy. She is a normally
delivered first child and was mature at birth. The girl
had not attended menarche.
On examination there was a 2 cm x 1.5
cm oval non-tender well-defined smooth firm
swelling in the right groin (above inguinal
ligament). There was no visible expansile cough
impulse or pulsation. It was neither reducible nor
Sonography revealed a soft tissue
structure resembling ovarian echotexture in the region
of the right inguinal canal with the absence of
the right ovary in the pelvis. However on
conducting a diagnostic laparoscopy it was evident
that the right ovary along with the right
fallopian tube was entering the deep inguinal ring
and there was no accessory or supernumerary
ovary nor any other congenital anomaly.
Exploration confirmed that the right ovary
and the right fallopian tube were the contents of the
hernia sac (Figure 1). Contents were replaced into
the abdominal cavity and a herniotomy
performed. Post-operative recovery was uneventful. At
further follow up the girl was asymptomatic.
During embryogenesis, the gubernaculum
and broad ligament suspend the ovary and
prevent its descent through the canal of Nuck
(processus vaginalis peritonei) to the base of the
labium major. The canal of Nuck is obliterated
by the 8th week of fetal life and the ovary is
then suspended between the cornu of the uterus
and the internal inguinal ring. The adult position
of the ovary is reached about the tenth year of
life. If the canal of Nuck remains open, the ovary
and the fallopian tube and sometimes even the
uterus may be forced through the canal to a
congenital hernia sac. Normally the inguinal canal in
a female contains the round ligament of the
uterus which emulates the gubernaculum in the male
Almost 30% of all reported cases are
related to adolescents or women of reproductive age
12. Occurrence of ovary and fallopian tubes in
inguinal hernia has been noted in premature infants
and this is related to defects in genital tract,
ovarian agenesis, Mullerian dysgenesis and
ambiguous genitalia (
). The lateral fusion defects
associated with Mullerian ductal development can
also lead to the rare congenital anomaly , hernia
uterus inguinale, a condition in which
endometrium and myometrium are found in an ectopic
location in the inguinal canal (9) . In our case
no such secondary sexual development defect
Out of the total incidence of female
inguinal hernias, approximately 4% to 37% cases
presented with non reducible ovaries at the time
of surgery, out of which 2% to 33% the ovary
was twisted and infarcted (
). Ovary is at
significant risk of torsion along with the fallopian
tube on its pedicle whilst suspended from the
neck of the hernia sac (
Though some cases have been managed
conservatively, early recognition and reduction of
an ovary is thought to be important to decrease
the risk of infarction (
). The presence of an
ovary in the inguinal canal requires laparoscopic
or conventional surgical exploration (
aim of operative management of this rare
anomaly is to preserve and reposition the ovary in
the abdominal cavity (
). Presented case also
was operated upon expeditiously with an
uneventful postoperative recovery.
In most cases, the contents of the
hernia sac can be detected intraoperatively.
Although considered to be a very rare entity, the
possibility of ovarian hernia should be kept in
mind in any young female patient presenting
with an irreducible swelling in the inguinal or
femoral region even without any cough impulse
in order to avoid serious complications like
ovarian torsion. Whenever suspected, it must be
treated as a surgical emergency. This case has
Inguinal hernia and ovary and fallopian tube
been presented for its rarity and its singular
presentation and to highlight the importance of
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