Incarcerated Torsion Ovarian Inguinal Hernia in a 4 Month-old Infant

Abstract

            Inguinal hernias are common in infants and children. The reported frequency ranges between 1% and 13% and increases to about 30% in preterm infants. The incidence is highest during the first year of life, with more than one-third of cases occurring in infants aged less than six months. Inguinal hernias tend to affect male infants more often than female infants, with documented ratios ranging between 3:1 and 10:1.

            In women, the round ligament is attached to the uterus near the origin of the fallopian tube, and a small evagination of parietal peritoneum accompanies the round ligament through the inguinal canal to the labium majorum. This small evagination of parietal peritoneum, named the Canal of Nuck in women, is the equivalent of processus vaginalis in men. Incomplete obliteration of the processus vaginalis causes indirect inguinal hernia or hydrocele of the Canal of Nuck, a very rare condition in women. In the case of a hernia of the Canal of Nuck in female infants, early diagnosis is important when the hernia contains an ovary, because incarceration of the ovary is common and has been reported in up to 43% of case. The reported frequency of torsion in various case series ranges between 2% and 33%. Early surgical intervention for the irreducible ovary is mainly guided by large retrospective chart reviews and case report recommendations, which document high rates of torsion or strangulation among patients with irreducible ovaries. High frequency ultrasonography is the first line diagnostic examination for the evaluation of inguinal lesions.

            Due to rarity of ovarian inguinal hernia. If there is no knowledge about the disease and choosing inappropriate or inadequate or delayed investigation, will lead to delayed diagnosis causing increase risk of complication. Therefore thoroughly history taking and physical examination, combined with the knowledge to realize this condition for appropriate and timely medical imaging that would be useful to help diagnose correctly and reduce potential harm from wrong or delayed diagnosis.

            Here I report on unusual contents within a hernia sac in a 4 month-old female infant who presented with a painful left inguinal mass and the torsion of left ovary was found in the sac. I report this case to describe the sonographic finding of ovary-containing hernia of the Canal of Nuck and its importance.