Hydrocele of the canal of Nuck: sonographic and MRI appearances

Nuck Cyst Presenting as a Recidive Inguinal Hernia: A Rare Case Treated in Plastic Surgery

The canal of Nuck is the female equivalent to the male processus vaginalis. Due to its rarity and the lack of awareness among physicians, a cyst in the canal of Nuck is a seldom-encountered entity in clinical practice and is commonly misdiagnosed. We report on a case of 42-year-old woman who presented with a painful swelling at her right groin and skin hypertrophy of the abdomen. The patient underwent successful open herniorrhaphy with excision of the cyst and mesh repair of the inguinal canal. The results were excellent both in the aesthetic and functional terms. In 1 month, there was a complete recovery with a return to social life. The 3-month healing score was 3 of 13 on the Vancouver Scar Scale. The technique is effective and reproducible. The patient's aesthetic and functional outcomes were excellent. In the following 6 months of follow-up, there were no recurrences or late complications.

Hydroceles of the Canal of Nuck in Adults-Diagnostic, Treatment and Results of a Rare Condition in Females

Nuck’s hydroceles, which develop in a protruding part of the parietal peritoneum into the female inguinal canal, are rare abnormalities and a cause of inguinal swelling, mostly resulting in pain. They appear when this evagination of the parietal peritoneum into the inguinal canal fails to obliterate. Our review of the literature on this topic included several case reports and two case series that presented cases of Nuck hydroceles which underwent surgical therapy. We present six consecutive cases of symptomatic hydroceles of Nuck’s canal from September 2016 to January 2020 at the Department of Surgery of Charité Berlin. Several of these patients had a long history of pain and consecutive consultations to outpatient clinics without diagnosis. These patients underwent laparoscopic or conventional excision and if needed simultaneous hernioplasty in our institution. Ultrasonography and/or Magnetic Resonance Imaging were used to display the cystic lesion in the inguinal area, providing the diagnosis of Nuck’s hydrocele. This finding was confirmed intraoperatively and by histopathological review. Ultrasound and magnetic resonance imaging (MRI) captures, intraoperative pictures and video of minimal invasive treatment are provided. Nuck’s hydroceles should be included in the differential diagnosis of an inguinal swelling. We recommend an open approach to external Type 1 Nuck´s hydroceles and a laparoscopic approach to intra-abdominal Type 2 Nuck hydroceles. Complex hydroceles like Type 3 have to be evaluated individually, as they are challenging and the surgical outcome is dependent on the surgeon’s skills. If inguinal channel has been widened by the presence of a Nuck’s hydrocele, a mesh plasty, as performed in hernia surgery, should be considered.

Cyst of the Canal of Nuck in adult females: A case report and systematic review

Defects in the Canal of Nuck are rare abnormalities of the female genitalia, which are typically detected and repaired in young age. In the present report, a case of a Nuck cyst in a 40-year old female patient is described. Additionally, the current literature concerning cases of women with hydrocele of Nuck canal was systematically reviewed. A total of 16 case reports of 16 patients with Nuck hydrocele (mean age of 35.18 years), have been reported to date. A right inguinal mass was noted in 13 patients (81.3%) whereas in 3 patients a left-sided mass was noted. The surgical approach was open in 13 cases and laparoscopic in 3 cases. Two cases underwent hydrocelectomy and inguinal ring ligation, whereas in 7 cases a simple cystectomy was performed. In 2 cases the round ligament was excised along with the hydrocele. In one of these 2, ligamentum rotundum necrosis and presence of a haemorrhagic cyst of the canal of Nuck were identified. Hernia repair and hydrocelectomy was performed in 5 cases. A cyst of the Canal of Nuck is relatively rare, but should be considered during the diagnosis of inguinal masses in female patients.

Hydrocele of the canal of Nuck presenting as a sausage-shaped mass

A 23-year-old woman presented with a painless vulval swelling. On physical examination, a soft fluctuant sausage-shaped mass was found, measuring approximately 4 cm, extending from the right inguinal region to the labia majora. Ultrasound revealed a well-defined hypoechoic elongated mass, septated, extending from the superficial inguinal canal to labia majora. Sonographic findings were consistent with the diagnosis of a hydrocele of the canal of Nuck. Surgical exploration revealed an elongated cystic lesion with a total length of 13 cm, mucous component and internal septations. Histopathological examination of the surgical specimen confirmed the suspected diagnosis.

Canal of Nuck hernia: a multimodality imaging review

Canal of Nuck abnormalities are a rare but important cause of morbidity in girls, most often those younger than 5 years of age. The canal of Nuck, which is the female equivalent of the male processus vaginalis, is a protrusion of parietal peritoneum that extends through the inguinal canal and terminates in the labia majora. The canal typically obliterates early in life, but in some cases the canal can partially or completely fail to close, potentially resulting in a hydrocele or hernia of pelvic contents. Recognition of this entity is especially important in cases of ovarian hernia due to the risk of incarceration and torsion. We aim to increase awareness of this condition by reviewing the embryology, anatomy and diagnosis of canal of Nuck disorders with imaging findings on US, CT and MRI using several cases from a single institution.

Cysts of the canal of Nuck: A rare sonographic diagnosis

The canal of Nuck is a remnant of a peritoneal evagination associated with the round ligament in women. Rarely, the canal of Nuck can remain patent allowing for development of cysts. These cysts are difficult to diagnose due to their rare incidence and because they are often mistaken for other causes of inguinal pain in women. This case series of three women presenting with groin or labial masses highlights the role of sonography as the primary imaging modality in the diagnosis of canal of Nuck cysts. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:175-178, 2017.

Hydrocele of the canal of Nuck: a case report with magnetic resonance hydrography findings

Hydrocele of the canal of Nuck, also called the "female hydrocele," is a rare developmental disorder in females. This entity is now believed to be more common now in comparison with previous reports; however, it is still an unfamiliar problem for physicians. The processus vaginalis accompanies the round ligament through the inguinal canal into the labium majus. This evagination of the parietal peritoneum forms the canal of Nuck in the female. The canal of Nuck normally loses its connection with the peritoneal cavity during the first year of life, but can result in a hernia or hydrocele when the connection of the canal of Nuck fails to close. Here, we present the case of a 43-year-old female who complained of swelling in the right inguinal region. Coronal and axial magnetic resonance imaging (MRI) revealed a cystic mass lesion with an irregular shape in the right inguinal region, and smaller cystic lesions extending alongside the right round ligament were also identified in the right side of the pelvic cavity. Magnetic resonance (MR) hydrography revealed the uninterrupted cystic lesion from the inguinal region to the pelvic cavity, with constrictions at the internal and external inguinal rings. These MR findings proved to be incredibly useful for surgical planning.

Cyst of Canal of Nuck

A cyst of the canal of Nuck is a rare condition that occurs when the processus vaginalis fails to obliterate during embryologic development. When a nonreducible groin mass is seen in women and girls, a cyst of the canal of Nuck should be considered in the differential diagnosis. Sonography has shown to be accurate and reliable at diagnosing these cysts and should be the primary imaging modality used to image groin masses.

Laparoscopic hernia repair--when is a hernia not a hernia?

The authors suggest that patients with atypical presenting features of hernia undergo a transabdominal approach to groin hernia repair because of greater diagnostic potential, rather than an extraperitoneal technique.

A wide range of diagnoses can present as inguinal hernia. Laparoscopic techniques are being increasingly used in the repair of inguinal hernias and offer the potential benefit of identifying additional pathology. The authors present the first reported case of a hydrocele of the canal of Nuck diagnosed laparoscopically. We review the incidence of identifying additional pathology through laparoscopy for inguinal hernia repair. We suggest that in patients with atypical presenting features of a hernia, the transabdominal preperitoneal, rather than a totally extraperitoneal, approach to groin hernia repair should be considered because of its greater diagnostic potential.

Hydrocele of the canal of Nuck: value of radiological diagnosis

Hydrocele of the canal of Nuck (cyst of the canal of Nuck) is the female homologue of hydrocele of the spermatic cord in males and is a rarely encountered entity, mostly diagnosed on the operating table at the time of suspected inguinal hernia surgery, as the clinical presentation usually is subtle and inconclusive. Diagnosis is mainly by ultrasound and has shown varied presentation of the same over the years. We discuss the sonographic findings of a case of hydrocele of the canal of Nuck.

Two cases of female hydrocele of the canal of nuck

The processus vaginalis within the inguinal canal forms the canal of Nuck, which is a homolog of the processus vaginalis in women. Incomplete obliteration of the processus vaginalis causes indirect inguinal hernia or hydrocele of the canal of Nuck, a very rare condition in women. Here, we report 2 cases of hydrocele of the canal of Nuck that were diagnosed with ultrasonography in both cases and magnetic resonance imaging in 1 case to confirm the sonographic diagnosis. High ligation and hydrocelectomy were conducted in both patients. In 1 patient, 14 months later, the occurrence of contralateral inguinal hernia was suspected, but did not require surgery. The other patient had a history of surgery for left inguinal hernia 11 months before the occurrence of right hydrocele of the canal of Nuck. In both cases, the occurrence of an inguinal hernia on the contralateral side was noted.

Cysts of the canal of Nuck: ultrasound and magnetic resonance imaging findings

Cyst of the canal of Nuck is a rare cause of inguinal swelling in woman. We report a case of a cyst of the canal of Nuck in which sonography showed a tubular cystic structure with internal septae localized within the inguinal canal. Magnetic resonance examination demonstrated that the mass was hypointense on T1-weighted and hyperintense on T2-weighted series and that there were fine hypointense septae inside the mass on the T2-weighted sequence. Diagnosis of cyst of the canal of Nuck was confirmed by surgery and subsequent histopathologic evaluation.

MR findings of a giant Bartholin's duct cyst

We describe the case of a 63-year-old woman with a large Bartholin's duct cyst that showed high signal intensity on T1- and T2-weighted magnetic resonance (MR) images. Although Bartholin's duct cyst is the most frequent cystic lesion of the vulva, such a giant cyst is rare.