Incarcerated ovarian herniation of the canal of Nuck in a female infant: Ultrasonographic findings and review of literature

Abstract

Introduction: Inguinal hernia with containing the ovary presenting as a palpable groin mass is an uncommon congenital condition, and it may cause complications such as strangulation, torsion, and infertility. We present a case of ovarian herniation into inguinal canal with sonographic findings.

Presentation of case: A 15-day-old infant girl visited our hospital with the complaints of palpable mass in the right groin. On physical examination, a palpable non-movable mass was found in the right inguinal region, and it was irreducible. During sonographic examination, a well-circumscribed solid mass containing small cysts was found. Then, oophorectomy with high inguinal ligation was performed, and the patient was doing well after surgery.

Discussion: The canal of Nuck is an abnormal patent pouch of the parietal peritoneum extending to the round ligament of the uterus into the labia majora through the inguinal ring. When this canal obliterates incompletely, inguinal herniation of ovary or hydrocele occur in the female children. In the clinical practice, ovarian herniation should be differentiated from a hernia containing intestine, fat, fluid, or lymph nodes. Therefore, a careful sonographic evaluation is mandatory to make an accurate diagnosis in female infants with palpable inguinal mass.

Conclusion: Ultrasound (US) with color Doppler US can be helpful to the diagnosis of ovarian herniation through the canal of Nuck and hernia-related complications.

Keywords: Canal of Nuck; Inguinal hernia; Ovary; Ultrasound.

Fig. 1

A 15-day-old female infant presented with palpable mass in the right inguinal region. A– C. Transverse (A) and longitudinal (B, C) gray scale ultrasound (US) reveals a well-circumscribed, oval, hypoechoic solid mass with internal small cysts in the right inguinal area, and there is no evidence of peristalsis or fat within the mass. And the lesion extends to the abdominal cavity through the canal of Nuck (arrows). These sonographic findings suggest that the herniated content is the right ovary. D, E. On color Doppler US, blood flow is seen at the canal of Nuck, representing ovarian vessel. However, no blood flow was seen within the mass. This finding strongly suggests a strangulation of the ovary.