|Year : 2016 | Volume
| Issue : 2 | Page : 84-86
Hernia uterine inguinale
Shahaji G Chavan, Sonu Sharma, Anuradha Dhyanmote, Neeraj C Chaudhari
Department of Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
|Date of Web Publication||8-Jun-2016|
Flat-302, Aster-3, Sukhwani Housing Society, Pimpri, Pune - 411 018, Maharashtra
Source of Support: None, Conflict of Interest: None
Inguinal hernia is relatively uncommon in females as compared to males. The incidence of inguinal hernia in females is 1.9%, the ratio of males to females being 6:1. Primary inguinal hernia occurs in 1-5% of all newborn and 9-11% of those born prematurely. Herniation of the contents through the canal of Nuck is a very rare condition. Approximately, 15-20% contain ovary, sometimes with a fallopian tube. A 1.5-month-old prematurely born female child presented with swelling in the left inguinal region since birth. A 3 cm × 2 cm solitary swelling was visible in the left inguinal region on crying, soft in consistency and reducible. A 2 cm × 1 cm swelling was also seen in umbilical region, soft in consistency and reducible. Ultrasonography - patent canal of Nuck with herniating ovary and part of uterus. The patient was subjected for surgery, content of an inguinal hernia was found to be uterus, with right fallopian tube and right ovary. Contents were reduced. Sac was transfixed and excised. When uterus and uterine adnexa are found in inguinal hernia sac, it is called as hernia uterine inguinale, or uterus-containing hernia. The anterior invagination of parietal peritoneum in females, which is canal of Nuck, is much smaller than the processus vaginalis its male counterpart. The canal of Nuck is often open in premature infants, which can lead to herniation of peritoneal contents such as bowel or the ovary, the fallopian tube, and the uterus. Our patient was a prematurely born infant. The hernial sac containing fallopian tube, ovary, and uterus in the female is very rare. We present a case of female inguinal hernia containing ovaries as well as uterus. The surgical dilemma occurs due to such rare condition at the time of hernia repair and should always be considered.
Keywords: Female, hernia uterine inguinale, infants, ovaries, uterus
|How to cite this article:|
Chavan SG, Sharma S, Dhyanmote A, Chaudhari NC. Hernia uterine inguinale. Saudi Surg J 2016;4:84-6
| Introduction|| |
Hernia containing uterus and uterine adenaxe as its content is defined as hernia uterine inguinale.  The incidence of inguinal hernia in females is 1.9%, the ratio of boys to girls 6:1.  It is of utmost importance that it be detected at the earliest to sidestep the tiresome and often fatal complications of incarceration of the contents. Inguinal hernias of the newborn era are encountered with a frequency of 1-2%, and the female:male ratio ranges between Ό and 1/10.  In 15-20% of the female patients with inguinal hernias, the herniation sac may contain ovaries and/or fallopian tube.  In the female, the counterpart structure of processus vaginalis which extends into inguinal canal is known as Nuck diverticulum. The persistence of this peritoneal opening is defined as Nuck cyst. This peritoneal sac gets obliterated by 8 th gestational month. Anomalies in nonobliterated canal may lead to the development of inguinal hernia. 
| Case Report|| |
A 1.5-month-old prematurely born female child was brought to the OPD by her mother with complaints of swelling in the left inguinal region since birth [Figure 1]. On examination, the patient was afebrile; heart rate was 124 beats/min. A 3 cm × 2 cm swelling was visible in the left inguinal region on crying, soft in consistency and reducible. A 2 cm × 1 cm swelling was also seen in umbilical region when the child cried, soft in consistency and reducible [Figure 2]. Blood investigations were within normal limits. Ultrasonography and magnetic resonance imaging - suggestive off patent canal of Nuck with herniating ovary and part of uterus. Intraoperative findings revealed content of hernia was found to be uterus, left fallopian tube with left ovary [Figure 3],[Figure 4] and [Figure 5]. Contents were reduced, and sac was transfixed. The procedure was uneventful [Figure 6].
| Discussion|| |
Inguinal hernia in females is relatively uncommon as compared to males. The incidence of inguinal hernia in females is 1.9%.  Although no risk factors for inguinal hernia in females are known, independent risk factors are positive family history and obstination.  Most reported cases concern the pediatric population in whom ovaries and tubal herniation have long been associated as unusual contents. Once diagnosis of inguinal hernia in a female is made, repair should be carried out promptly because incarceration occurs in the 1 st year of life. Uterus as content of hernial sac is still rarer with thorough literature search; there were only few cases of hernia in female infants containing uterus.  Hernia of the canal of Nuck is rare condition and around 15-20% contain ovary, sometimes fallopian tube.
| Conclusion|| |
An indirect inguinal hernia containing the entire uterus, ovaries, and fallopian tubes is extremely rare in pediatric age group.  Hence, we report a case of an inguinal hernia in a female child with contents as uterus, fallopian tube, and ovary. It is of utmost importance that it be detected at the earliest to sidestep the tiresome and often fatal complications of incarceration of the contents.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Akillioglu I, Kaymakci A, Akkoyun I, Güven S, Yücesan S, Hiçsönmez A. Inguinal hernias containing the uterus: A case series of 7 female children. J Pediatr Surg 2013;48:2157-9.
Read RC, White HJ. Inguinal herniation 1777-1977. Am J Surg 1978;136:651-4.
Huang CS, Luo CC, Chao HC, Chu SM, Yu YJ, Yen JB. The presentation of asymptomatic palpable movable mass in female inguinal hernia. Eur J Pediatr 2003;162:493-5.
Laing FC, Townsend BA, Rodriguez JR. Ovary-containing hernia in a premature infant: Sonographic diagnosis. J Ultrasound Med 2007;26:985-7.
Wei BP, Castles L, Stewart KA. Hydrocele of the canal of nuck. ANZ J Surg 2002;72:603-5.
Kaplan SA, Synder WH, Little S. Inguinal hernia in females and testicular feminization syndrome. Am J Dis Child 1969;117:43-51.
Mayer V, Templeton FG. Inguina ectopia of the ovary and fallopian tube. Review of the literature and report of the case of an infant. Arch Surg 1941;43:397-408.
Kamio M, Nagata T, Yamasaki H, Yoshinaga M, Douchi T. Inguinal hernia containing functioning, rudimentary uterine horn and endometriosis. Obstet Gynecol 2009;113(2 Pt 2):563-6.
Okada T, Sasaki S, Honda S, Miyagi H, Minato M, Todo S. Irreducible indirect inguinal hernia containing uterus, ovaries, and fallopian tubes. Hernia 2012;16:471-3.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]