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Case Reports
. 2020 Aug 11;13(8):e237169.
doi: 10.1136/bcr-2020-237169.

Rare encounter: hydrocoele of canal of Nuck in a Scottish rural hospital during the COVID-19 pandemic

Affiliations
Case Reports

Rare encounter: hydrocoele of canal of Nuck in a Scottish rural hospital during the COVID-19 pandemic

Michael Scott et al. BMJ Case Rep. .

Abstract

We report the case of a 32-year-old woman who presented with reducible indirect inguinal hernia and a challenging constellation of symptoms, signs and radiographic findings. Surgical approach superseded conservative management when the patient's abdomen became acute, with a rising lactate and haemodynamic instability. Specifically, the presence of a fluid collection was concerning for sinister acute pathology. Our patient was rediagnosed intraoperatively with hydrocoele of canal of Nuck. This so-called 'female hydrocoele' is an eponymous anatomical rarity in general surgery, presenting as an inguinolabial swelling with variable clinical profile. Hydrocoele of canal of Nuck takes origin from failure of transitory reproductive anlagen to regress and is thus analogous to patent processus vaginalis. Its true incidence is speculative, with just several hundred cases globally. We aim to provide insights into surgical patient management for a rare entity during the COVID-19 outbreak, from the unique perspective of a small rural hospital in Scotland.

Keywords: general surgery; surgery; urology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Transverse Doppler ultrasound scan demonstrating an anechoic, defined tubular cystic structure with a thin septation in the left inguinal region.
Figure 2
Figure 2
Contrast enhanced axial CT scan demonstrating a non-enhancing fluid collection, located medially to the femoral vessels in the left inguinal canal.
Figure 3
Figure 3
Contrast enhanced sagittal CT reconstructed image demonstrating a non-enhancing fluid collection located in the left inguinal canal, demonstrating no soft-tissue internal component.
Figure 4
Figure 4
Hydrocoele of canal of Nuck diagram, demonstrating patent processus vaginalis with concomitant hydrocoele. The position of the hydrocoele varies anywhere from the superficial ring distally. Incomplete proximal and distal obliteration of the processus vaginalis will cause the hydrocoele to assume an encysted morphology. Illustrated independently by AH, corresponding author.

References

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