The Rarest Variant Type Of Groin Cystic Mass In Adult Female: Encysted Hydrocele Canal Of Nuck

Abstract

Introduction and importance: Hydrocele canal of the nuck is one of the rarest clinical conditions encountered in adult females. It occurs as a result of a failure to obliterate the canal.

Case presentation: This case report details the surgical treatment in 25 - years old young female presented to the surgical clinic with a one-month history of right-sided painful palpable inguinolabial swelling. A large well-circumscribed cystic lesion with multiseptated, thin walls with no evident peritoneal cavity connectivity was seen on abdominal sonography and enhanced computerized tomography (CT) scan. The patient underwent surgical exploration, and the intraoperative findings revealed an encysted hydrocele distally at the external inguinal ring, with the canal of nuck partially obliterated in the midpoint and the proximal end communicating with a peritoneal cavity at the deep inguinal ring. The hydrocele and round ligament were excised, the canal of the nuck was high-ligatured, and the self-fixing prosthetic mesh was then utilized to repair the anatomical defect through the right inguinal skin creases approach. The patient had a smooth post-operative recovery and was discharged the next day with outpatient surveillance. The patient rested asymptomatic and experienced no recurrence three months after surgery.

Clinical discussion: Female hydrocele, often called "hydrocele canal of nuck," is a rare developmental abnormality that typically presents later in life, and the condition is poorly understood among surgeons due to the lack of information on this clinical entity in surgical and gynecological textbooks, as well as the rarity of the disorder itself, both of these factors contribute to misdiagnosing as an irreducible inguinal hernia or a femoral hernia is possible in practice.

Conclusion: Hydrocele ultrasound-guided aspiration has no place in surgical practice. The surgical exploration approach is the only practical and standard therapy.

Keywords: Aspiration; Canal of nuck; Cyst; Encysted; Female; Hydrocele; Surgery.

Fig. 1

Abdominal sonography showed a large cystic lesion around 5.8 × 3.1 with internal septation (A). No internal or peripheral vascularity was demonstrated (B) Ct axial raveled a comma-like-cyst (D).

Fig. 2

(A) View shows rounded cystic lesion. (B) Encysted hydrocele was separated from underlying structures. (C) The distal hydrocele dissection en mass. (D) Fluid-filled cyst observed. (E) Cyst connected freely within the peritoneal cavity proximally, the process vaginalis “i.e. canal of nuck” at midpoint was partially patent this finding is equivalent to hydrocele type III “hour-glass”. (F) Histopathological slide hydrocele-typical features, including a mesothelial-lined cavity containing fibro adipose tissue and smooth muscle.

Illustration 1

This is a drawing illustration demonstrated the present case. Type III hydrocele had a combination of enclosed encysted hydrocele and peritoneal cavity -communicating cyst with the construction of process vaginalasis ‘canal of Nuck’ at the midpoint of the deep inguinal ring which gave a characteristic shape of the hour-glass cyst.