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Journal of Pioneering Medical Sciences
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Ovarian inguinal hernia is an extremely rare condition. However, it is more common in infants and young females than in adults. The occurrence of inguinal hernias in adult females is usually due to failure in the closure of the processus vaginalis (which is usually obliterated by the eighth month of gestation ). The association between the ovary-containing inguinal hernias and Mullerian duct anomalies is not well established. Commonly, inguinal ovarian hernia is present in infant females and rarely presents in adults. However, when observed in adults, the presentation is generally acute and rarely as chronic abdomen. In infants, the diagnosis is usually made preoperatively with ultrasonography whereas in adults, the diagnosis is intra-operative for acute presentation.Here we report a case of 32 year old female patients who presented with a Mullerian duct anomaly and an adult presentation of an ovarian inguinal hernia as chronic abdomen.
Inguinal hernias containing ovaries are uncommon, moreover, it is even rarer in adult females compared to infants and young females. Inguinal hernias occur due to failure in the closure of the processus vaginalis [1,2]. These types of hernias are frequently found more in children, often in association with genital tract anomalies [3].
A 32year-old obese (Body Mass Index = 33 ) female patient presented with chronic left groin pain for the last 5 years. She had visited multiple hospitals previously where diagnostic imaging findings were negative, hence, she was diagnosed with irritable bowel syndrome ( IBS ). At our institution, she was followed-up at the department of urology clinic for her single kidney that was discovered incidentally on previous computed tomography (CT) scan of the abdomen and pelvis. She was referred to the surgical clinic for chronic abdominal pain. On examination, the surgeon noticed a left inguinal tenderness and swelling; however, owing to her obesity, clinical examination was difficult for diagnosis. Therefore, contrast-enhanced CT scan of the abdomen and pelvis was advised. CT showed an elongated structure herniating through the left inguinal canal (Figure 1 A). Additionally, the uterus was small in size and lying on the right side(Figure 1 B). Following the vascular supply, it revealed drainage in the left renal vein, which in turn drained a very diminutive left-sided renal tissue (Figure 1 C,D), confirming it as an ovary. Moreover, it was connected to the uterus by a small band. Therefore, the magnetic resonance imaging (MRI) of the pelvis was performed. MRI confirmed the diagnosis of unicornuate uterus and herniating left ovary. (Figure 1 E,F).
The surgeon advised laproscopic hernia mesh repair to relief her chronic abdominal pain. The patient provided consent for this, and underwent the procedure one week later. Exploratory laparoscopy confirmed a left indirect inguinal hernia with a viable left ovary as the hernial content adherent to the left external iliac vessels ( Figure 1 G, H ). Reduction of the left ovary and dissecting it off of the left external iliac vessels were safely made. Preperitoneal mesh plug and mesh hernioplasty followed by peritoneorrhaphy were successfully achieved ( Figure 1 I,K ).
The patient recovered well after surgery and was pain-free at the 1-year follow-up, with no clinical or radiological evidence of recurrence.