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Lakshmi A D, Subramaniam B. Hydrocele of the Canal of Nuck: A Rare Case. Cureus 2024; 16:e63672. [PMID: 39092341 PMCID: PMC11293481 DOI: 10.7759/cureus.63672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
Hydrocele of the canal of Nuck in adults is an extremely rare condition. It results from the incomplete obliteration of the processus vaginalis, which is a tubular structure that connects the peritoneal cavity to the labia majora during foetal development. Failure of this structure to close can lead to the accumulation of peritoneal fluid in the inguinal canal, resulting in a hydrocele. A 40-year-old lady presented to our OPD with a history of left groin pain and tenderness of one-year duration. No obvious swelling was noted clinically. No other clinical abnormality was seen. An ultrasonogram and MRI of the pelvis played a key role in arriving at a diagnosis. She was then taken up for excision of the hydrocele along its entire extent. Though a rare presentation, it should be among the differential diagnosis in a female with inguinal pain or an inguinal swelling. Accurate diagnosis through imaging and appropriate surgical management can lead to favourable outcomes.
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Affiliation(s)
- Divya Lakshmi A
- Department of Pediatrics, Sree Balaji Medical College & Hospital, Chennai, IND
| | - Balaji Subramaniam
- Department of Urology, SRM Medical College Hospital & Research Centre, Chennai, IND
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Nakamura K, Higashiguchi T, Chikaishi Y, Matsuo K, Endo T, Morohara K, Kikuchi K, Shibasaki S, Katsuno H, Uyama I, Suda K, Morise Z. Totally laparoscopic surgery for a hydrocele of the canal of Nuck extending from the abdominal cavity to the subcutaneous space: a case report. Surg Case Rep 2024; 10:31. [PMID: 38302668 PMCID: PMC10834912 DOI: 10.1186/s40792-024-01825-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Hydrocele of the canal of Nuck (HCN) is a rare disease, and its indications for laparoscopic surgery are not well-established. CASE PRESENTATION A 53-year-old woman was referred to our hospital due to an uncomfortable thumb-sized inguinal mass. Preoperative computed tomography scan and magnetic resonance imaging revealed a hydrocele extending from the abdominal cavity around the left deep inguinal ring via the inguinal canal to the subcutaneous space. The patient was diagnosed with HCN protruding into the abdominal cavity and extending to the subcutaneous space. Laparoscopy can easily access the hydrocele protruding into the abdominal cavity. Furthermore, laparoscopic hernioplasty can be superior to the anterior approach for females. Hence, laparoscopic surgery was performed. After transecting the round ligament of the uterus, a tense 3-cm hydrocele was dissected with it. In order to approach the hydrocele distal to the deep inguinal ring, the transversalis fascia was incised medially to the inferior epigastric vessels. The subcutaneously connected hydrocele was excised from the incision. Then, the enlarged deep inguinal ring was reinforced using a mesh with the laparoscopic transabdominal preperitoneal approach. The patient was discharged 2 days postoperatively. Laparoscopic resection can be more effective for a hydrocele protruding into the abdominal cavity as it facilitates an easy access to the hydrocele. Moreover, laparoscopic resection of a hydrocele extending from the inguinal canal to the subcutaneous space via a transversalis fascia incision can be safer, with low risk of injury to the inferior epigastric vessels. The incised transversalis fascia and the enlarged deep inguinal ring due to the HCN were simultaneously repaired with the laparoscopic transabdominal preperitoneal repair. There are two reports on laparoscopic resection via a transversalis fascia incision for HCNs located between the inguinal canal and the subcutaneous space, which does not require intraperitoneal hydrocelectomy. However, this is the first report on laparoscopic resection of large HCNs protruding into the abdominal cavity and extending beyond the inguinal canal into the subcutaneous space via intraperitoneal hydrocelectomy and a transversalis fascia incision. CONCLUSIONS Laparoscopic surgery with transversalis fascia incision can be useful for HCNs extending from the abdominal cavity to the subcutaneous space.
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Affiliation(s)
- Kenichi Nakamura
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan.
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Takahiko Higashiguchi
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Yuko Chikaishi
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Kazuhiro Matsuo
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Koji Morohara
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Kenji Kikuchi
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Susumu Shibasaki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
- Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Zenichi Morise
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
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Kohlhauser M, Pirsch JV, Maier T, Viertler C, Fegerl R. The Cyst of the Canal of Nuck: Anatomy, Diagnostic and Treatment of a Very Rare Diagnosis-A Case Report of an Adult Woman and Narrative Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1353. [PMID: 36295514 PMCID: PMC9609622 DOI: 10.3390/medicina58101353] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 08/25/2023]
Abstract
The cyst of the canal of Nuck is an extremely rare female hydrocele, usually occurring in children, but also in adult women. It is caused by pathology of the canal of Nuck, which is the female equivalent to the male processus vaginalis. Due to its rarity and the lack of awareness among physicians, the cyst of the canal of Nuck is a seldom-encountered entity in clinical practice and is commonly misdiagnosed. We report on a case of cyst of the canal of Nuck in a 42-year-old woman, who presented with a painful swelling at her right groin. In addition, we conducted a review of the current available literature. This review gives an overview of the anatomy, pathology, diagnostics, and treatment of the cyst of the canal of Nuck. The aim of this review is not only to give a survey, but also to raise awareness of the cyst of the canal of Nuck and serve as a reference for medical professionals.
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Affiliation(s)
- Michael Kohlhauser
- Department of Surgery, State Hospital Weiz, Styrian Hospital Association (KAGes), 8160 Weiz, Austria
| | - Julian Vinzent Pirsch
- Department of Surgery, State Hospital Weiz, Styrian Hospital Association (KAGes), 8160 Weiz, Austria
| | - Thorsten Maier
- Radiological Center Weiz, Institute for CT and MRI Weiz OG, 8160 Weiz, Austria
| | - Christian Viertler
- Diagnostic and Research Institute of Pathology, Medical University of Graz, 8010 Graz, Austria
| | - Roland Fegerl
- Department of Surgery, State Hospital Weiz, Styrian Hospital Association (KAGes), 8160 Weiz, Austria
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Andrew MS, Poon C. A Rare Case of a Giant Vulval Fibroepithelial Stromal Polyp. J Pediatr Adolesc Gynecol 2022; 35:501-504. [PMID: 35123056 DOI: 10.1016/j.jpag.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/22/2021] [Accepted: 01/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND A fibroepithelial stromal polyp is an uncommon benign pathology of the female genital tract. Rarely, these benign tumors present as a giant lesion and are clinically difficulty to distinguish from other pathologies. CASE A 19-year-old female presented with a vulval fibroepithelial stromal polyp measuring ∼8 × 8 × 3 cm that extended from the right labia majora. Present for 2 years, the lesion caused mild discomfort and aesthetic dissatisfaction due to its size but otherwise had no associated symptoms. It was diagnosed using a combination of imaging techniques including ultrasound and magnetic resonance imaging and histological analysis. It was removed surgically and has had no recurrence. SUMMARY AND CONCLUSION The consideration of both benign and malignant pathologies is paramount when differentiating vulval masses. Thorough clinical reasoning and appropriate use of imaging modalities and histological analysis are essential.
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Affiliation(s)
- Madison S Andrew
- Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia 3168.
| | - Carolin Poon
- Mercy Hospital for Women, Mercy Health, 163 Studley Road, Heidelberg 3084 Victoria, Australia
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Abstract
Canal of Nuck abnormality is a rare surgical condition. The pathologies are mostly encountered in young girls, less than five years of age. The incidence is even less in adults. Various pathologic conditions related to the failure of processus vaginalis obliteration can occur, involving herniation of intraabdominal structures including intestinal and genital contents such as the uterus, fallopian tube, and ovary and hydrocele of the canal of Nuck. According to its rarity, hydrocele of canal of Nuck is often misdiagnosed for common groin masses. This review summarizes and simplifies embryology, the pathophysiology of the canal of Nuck abnormalities, imaging findings, and treatment options with emphasis on the hydrocele.
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6
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Wang L, Maejima T, Fukahori S, Shun K, Yoshikawa D, Kono T. Laparoscopic surgical treatment for hydrocele of canal of Nuck: A case report and literature review. Surg Case Rep 2021; 7:121. [PMID: 33983554 PMCID: PMC8119562 DOI: 10.1186/s40792-021-01205-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
Background Hydrocele of canal of Nuck (HCN) is a rare disease in adult female. The diagnosis and treatment of HCN is still a challenge for surgeons. Case presentation A 56-year-old female presented with recent onset of occasional pain during exercise and an asymptomatic left groin swelling. Ultrasonography results were suspicious for left inguinal hernia incarceration and computed tomography (CT) scan showed no intestinal obstruction, which was considered as HCN. Laparoscopic hydrocelectomy of the HCN and a routine laparoscopic hernia repair via the transabdominal preperitoneal (TAPP) approach were performed. Postoperative pathology showed no malignant lesions or endometriosis. Conclusions The preoperative diagnosis of HCN is extremely important. Surgeons should choose appropriate surgical methods for different anatomical HCNs based on the preoperative diagnosis.
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Affiliation(s)
- Liming Wang
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan.
| | - Taku Maejima
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Susumu Fukahori
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Katayose Shun
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Daitaro Yoshikawa
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Toru Kono
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
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Wang L, Maejima T, Fukahori S, Shun K, Yoshikawa D, Kono T. Laparoscopic assisted hydrocelectomy of the canal of Nuck: a case report. Surg Case Rep 2021; 7:52. [PMID: 33599854 PMCID: PMC7892654 DOI: 10.1186/s40792-021-01137-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Accurate diagnosis and complete resection of hydrocele of canal of Nuck (HCN) is still a challenge for surgeons. Case presentation A 28-year-old woman presented with a suspected inguinal hernia due to swelling in her right groin and was introduced for surgical treatment. Computed tomography scan revealed local cyst formation in the right groin and eliminated intestinal incarceration. In order to further confirm the diagnosis, we used laparoscopic exploration; after excluding a combined hernia, HCN was surgically removed using a conventional anterior peritoneal approach and a mesh patch repair was not needed. Postoperative pathology results showed no endometriosis or malignancy. Conclusions Laparoscopic assisted anterior approach provides both an accurate intraoperative diagnosis and a quick complete resection of HCN; it is the preferred treatment for women of childbearing age with pure HCN.
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Affiliation(s)
- Liming Wang
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan.
| | - Taku Maejima
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Susumu Fukahori
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Katayose Shun
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Daitaro Yoshikawa
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Toru Kono
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
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Fikatas P, Megas IF, Mantouvalou K, Alkatout I, Chopra SS, Biebl M, Pratschke J, Raakow J. Hydroceles of the Canal of Nuck in Adults-Diagnostic, Treatment and Results of a Rare Condition in Females. J Clin Med 2020; 9:jcm9124026. [PMID: 33322831 PMCID: PMC7763523 DOI: 10.3390/jcm9124026] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Panagiotis Fikatas
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany; (I.-F.M.); (K.M.); (S.S.C.); (M.B.); (J.P.); (J.R.)
- Correspondence:
| | - Ioannis-Fivos Megas
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany; (I.-F.M.); (K.M.); (S.S.C.); (M.B.); (J.P.); (J.R.)
| | - Kiriaki Mantouvalou
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany; (I.-F.M.); (K.M.); (S.S.C.); (M.B.); (J.P.); (J.R.)
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, Kiel School of Gynecological Endoscopy, University Hospital Schleswig Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany;
| | - Sascha S. Chopra
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany; (I.-F.M.); (K.M.); (S.S.C.); (M.B.); (J.P.); (J.R.)
| | - Matthias Biebl
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany; (I.-F.M.); (K.M.); (S.S.C.); (M.B.); (J.P.); (J.R.)
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany; (I.-F.M.); (K.M.); (S.S.C.); (M.B.); (J.P.); (J.R.)
| | - Jonas Raakow
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augistenburger Platz 1, 13353 Berlin, Germany; (I.-F.M.); (K.M.); (S.S.C.); (M.B.); (J.P.); (J.R.)
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Kohata A, Hirata Y, Ishikawa S, Kai A, Namba Y, Okimoto S, Mukai S, Fujisaki S, Takahashi M, Fukuda T, Nishida T. Large hydrocele of the canal of Nuck diagnosed and treated using conventional and laparoscopic methods. J Surg Case Rep 2020; 2020:rjaa222. [PMID: 32864093 PMCID: PMC7446026 DOI: 10.1093/jscr/rjaa222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/08/2020] [Indexed: 11/14/2022] Open
Abstract
A 49-year-old woman presented to the hospital with a right inguinal swelling. On examination, we suspected hydrocele of the canal of Nuck (HCN) or an appendiceal or retroperitoneal tumor. Surgery for diagnosis and removal of the mass revealed that it was large and located in the preperitoneal cavity, extending into the inguinal ring; so, it was difficult to observe the entire outline of the mass solely using the laparoscopic approach. Therefore, we added the conventional approach with an inguinal incision. This combination of conventional and laparoscopic approaches helped in safe removal of the tumor. The HCN is an unusual developmental condition in women among whom it might cause an inguinal swelling infrequently. In a case with a large HCN, a combined approach using conventional and laparoscopic methods is suggested for better observation of the abdomen and successful resection without perforation of the mass than when using a single approach.
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Affiliation(s)
- Akihiro Kohata
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuzo Hirata
- Department of Surgery, Saiseikai Hiroshima Hospital, Hiroshima, Japan
| | - Sho Ishikawa
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
| | - Azusa Kai
- Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yosuke Namba
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Sho Okimoto
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Shoichiro Mukai
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Seiji Fujisaki
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | | | | | - Toshihiro Nishida
- Department of Diagnostic Pathology, Chugoku Rosai Hospital, Hiroshima, Japan
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Scott M, Helmy AH. Rare encounter: hydrocoele of canal of Nuck in a Scottish rural hospital during the COVID-19 pandemic. BMJ Case Rep 2020; 13:e237169. [PMID: 32784235 PMCID: PMC7418684 DOI: 10.1136/bcr-2020-237169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 11/04/2022] Open
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.
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Affiliation(s)
- Michael Scott
- General Surgery, NHS Highland, Fort William, Scotland, UK
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11
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Kojima S, Sakamoto T. Laparoscopic total extraperitoneal treatment for a hydrocele of the canal of Nuck located entirely within the inguinal canal: A case report. Asian J Endosc Surg 2020; 13:453-456. [PMID: 31801175 DOI: 10.1111/ases.12769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/22/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022]
Abstract
A 43-year-old woman was diagnosed with a hydrocele of the canal of Nuck, for which laparoscopic total extraperitoneal excision was successfully undertaken. The hydrocele was located entirely within the inguinal canal and was barely visible at the internal inguinal ring, even with strong retraction. The inferior epigastric vessels were at risk of injury secondary to excessive tension when retracting the round ligament. To overcome these problems, the hydrocele was approached from the medial side of the inferior epigastric vessels across the transversalis fascia. This approach allowed us to reach the distal end of the hydrocele and avoid excessive traction on the vessels. Thus, a hydrocele of the canal of Nuck can be addressed successfully with minimally invasive laparoscopic total extraperitoneal excision. Approaching the hydrocele from the medial side of the inferior epigastric vessels across the transversalis fascia may be useful.
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Affiliation(s)
- Shigehiro Kojima
- Department of Surgery, Sainokuni Higashiomiya Medical Center, Saitama, Japan
| | - Tsuguo Sakamoto
- Department of Surgery, Sainokuni Higashiomiya Medical Center, Saitama, Japan
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12
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Hydrocele of the Canal of Nuck with Endometriosis: Right-Side Dominance Confirmed by Literature Review and Statistical Analysis. Case Rep Pathol 2020; 2020:2567267. [PMID: 32695544 PMCID: PMC7368960 DOI: 10.1155/2020/2567267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction. The canal of Nuck is an embryological remnant of the peritoneal pouch that extends into the labium majus of women. Hydrocele is the most common presentation, but only a small number of cases are reported in association with endometriosis. Case Presentation. The patient is a 45-year-old woman who presented with left inguinal mass with persistent pain. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 30 mm cystic mass, and a hydrocele of the canal of Nuck (HCN) was suspected. The excised mass was a cyst containing yellow-tan serous fluid, and the cyst wall was lined by mesothelium. The morphology was consistent with conventional HCN. However, since several foci of endometrial-like epithelium and stroma were identified beneath the mesothelium, the mass was diagnosed with HCN with endometriosis (EM-HCN). Discussion. Right-side dominance of EM-HCN is suggested by several authors, but a thorough review has never been performed. For the first time, we reviewed the literature and statistically confirmed that EM-HCNs dominantly occur on the right side compared to those without endometriosis. We consider that this supports the theory that endometriosis derives from retrograde menstruation of endometrial tissue through fallopian tubes. When endometriosis is discovered in HCN, the clinician should be aware of the possibility of pelvic endometriosis.
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13
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Prodromidou A, Paspala A, Schizas D, Spartalis E, Nastos C, Machairas N. Cyst of the Canal of Nuck in adult females: A case report and systematic review. Biomed Rep 2020; 12:333-338. [PMID: 32346477 DOI: 10.3892/br.2020.1295] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/03/2020] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- Anastasia Prodromidou
- Department of Surgery, Division of Surgical Oncology, Metaxa Cancer Memorial Hospital, Piraeus 18573, Greece
| | - Anna Paspala
- Third Department of Surgery, Attiko University Hospital, National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Laiko General Hospital, Athens 11527, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Constantinos Nastos
- Third Department of Surgery, Attiko University Hospital, National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Nikolaos Machairas
- Third Department of Surgery, Attiko University Hospital, National and Kapodistrian University of Athens, Athens 12462, Greece
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Shahid F, El Ansari W, Ben-Gashir M, Abdelaal A. Laparoscopic hydrocelectomy of the canal of Nuck in adult female: Case report and literature review. Int J Surg Case Rep 2019; 66:338-341. [PMID: 31918159 PMCID: PMC7013182 DOI: 10.1016/j.ijscr.2019.11.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/30/2019] [Accepted: 12/10/2019] [Indexed: 11/28/2022] Open
Abstract
A very rare case of hydrocele of canal of Nuck in elderly lady. This case expands the clinical and intraoperative potential differential diagnosis of adult female groin masses. Hydrocele of canal of Nuck must be considered one of the differential diagnosis in ladies with inguinal masses. Laparoscopic TAPP is superior to open approach in managing such cases. Probably the first case of hydrocele of canal of Nuck in adult female operated laparoscopically in the Middle East and North Africa (MENA) Region, and the fourth such case worldwide.
Introduction Among adult females, Hydrocele of Canal of Nuck (HCN) is a very rare condition. The majority of the reported cases of HCN were not conclusively diagnosed until surgery was performed on a suspected inguinal hernia. To the best of our knowledge, this is the first case of laparoscopically operated HCN in adult female in Middle East and North Africa Region, and the fourth such case worldwide. Presentation of case A 36-year-old female presented with a painful small swelling in the right groin of 3 months duration. The swelling extended to the right labia majora while standing, and disappeared when the patient was in prone position. There was no lymph node enlargement, no other masses in the abdomen, and no swelling in the contralateral side. Ultrasonography was undertaken and the patient was admitted electively for laparoscopic exploration and repair of non-complicated right inguinal hernia. She was known to have dyslipidemia on medications. Further history and physical examination were unremarkable. Intraoperatively it was diagnosed to be right-sided HCN which was excised and repaired by mesh fixation using transabdominal preperitoneal (TAPP) approach. Her follow up course was unremarkable. Conclusions This case expands the clinical and intraoperative potential differential diagnosis of adult female groin masses. Surgeons should consider such cases when they observe such swellings intraoperatively. Laparoscopic TAPP approach in such cases is a superior diagnostic and treatment modality.
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Affiliation(s)
- Fakhar Shahid
- Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; School of Health and Education, University of Skövde, Skövde, Sweden.
| | - Mohamed Ben-Gashir
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.
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15
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Chen D, Zhang P, Zhang H, Guo M, Wang W, Zhang Z. Resection of mesothelial cyst of uterine round ligament by laparoscopic transabdominal preperitoneal procedure alone or combined with open surgery. J Int Med Res 2019; 47:5475-5482. [PMID: 31378110 PMCID: PMC6862916 DOI: 10.1177/0300060519865629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective Surgical treatment of a mesothelial cyst of the uterine round ligament (MCURL), an uncommon entity, has been rarely documented. In this article, we present our experience with excision of MCURLs. Methods The records of all female patients undergoing surgical removal of a groin mass in our department from March 2013 to November 2018 were retrospectively reviewed. Demographic information, clinical data, and follow-up outcomes were collected and analyzed. Results Among 298 women who underwent groin hernia repair, 17 (5.7%) had MCURLs. Of these 17 patients, 13 were aged 30 to 45 years and 15 had a normal body mass index (18.5–23.9 kg/m2). MCURLs occurred predominantly on the right side (11/17). Approximately half of the patients (9/17) were preoperatively misdiagnosed with inguinal hernias. Approximately 70% (12/17) of the lesions were localized medially to the inner ring of the inguinal canal and excised by a laparoscopic transabdominal preperitoneal (TAPP) procedure alone. Five patients required open surgery following the TAPP procedure because the cyst extended distally beyond the inner ring. No recurrence was noted during the entire follow-up period. Conclusion Most MCURLs were localized medially to the inner ring of the inguinal canal and could be excised by a TAPP procedure.
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Affiliation(s)
- Dongfeng Chen
- Department of General Surgery, Linyi People's Hospital, Linyi, Shandong Province, China
| | - Pan Zhang
- Visiting doctor, Department of General Surgery, Rehabilitation Hospital of Lanshan District, Linyi, Shandong Province, China
| | - Haifeng Zhang
- Department of General Surgery, Linyi People's Hospital, Linyi, Shandong Province, China
| | - Mingxiao Guo
- Department of General Surgery, Linyi People's Hospital, Linyi, Shandong Province, China
| | - Weijia Wang
- Department of General Surgery, Linyi People's Hospital, Linyi, Shandong Province, China
| | - Zhaoyong Zhang
- Department of General Surgery, Linyi People's Hospital, Linyi, Shandong Province, China
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16
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Chihara N, Taniai N, Suzuki H, Nakata R, Shioda M, Yoshida H. Use of a Novel Open Posterior Wall Technique for Laparoscopic Excision of Hydrocele of the Canal of Nuck in an Adult Female: Case Report. J NIPPON MED SCH 2019; 86:345-348. [PMID: 31204382 DOI: 10.1272/jnms.jnms.2019_86-601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Complete surgical excision is the standard treatment for hydrocele of the canal of Nuck. We developed a novel open posterior wall technique for laparoscopic transabdominal pre-peritoneal (TAPP) excision. A 38-year-old woman with a 5-month history of a painless reducible lump in the right groin had recently noticed a slight increase in the size of lump. Computed tomography showed a simple cystic lesion measuring 30 × 27.5 mm. We performed laparoscopic excision of the hydrocele by using the TAPP approach and the open posterior wall technique developed by us. Complete excision of the hydrocele was satisfactorily performed because the region from the external inguinal ring to the periphery could be clearly observed. After an uneventful postoperative course, the patient was discharged. Laparoscopic TAPP excision with open posterior wall technique was useful for complete excision of hydrocele of the canal of Nuck.
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Affiliation(s)
- Naoto Chihara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Nobuhiko Taniai
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Hideyuki Suzuki
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Ryosuke Nakata
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Mio Shioda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
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17
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Sun W, Fei X, Jiang M, Zhang Z, Li D. Regarding "Cyst of Nuck: A Disregarded Pathology". J Minim Invasive Gynecol 2018; 25:931-932. [PMID: 29626677 DOI: 10.1016/j.jmig.2018.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 03/13/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Wenchao Sun
- Center of Reproductive Medicine, Hangzhou Women's Hospital, Hangzhou, China
| | - Xiaoyang Fei
- Center of Reproductive Medicine, Hangzhou Women's Hospital, Hangzhou, China
| | - Meiyan Jiang
- Center of Reproductive Medicine, Hangzhou Women's Hospital, Hangzhou, China
| | - Zhifen Zhang
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, China
| | - Dingheng Li
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, China
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18
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Ferreira AF, Marques JP, Falcão F. Hydrocele of the canal of Nuck presenting as a sausage-shaped mass. BMJ Case Rep 2017; 2017:bcr-2017-221024. [PMID: 28978588 DOI: 10.1136/bcr-2017-221024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Ana Filipa Ferreira
- Gynecology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Medical School, University of Coimbra, Coimbra, Portugal
| | - João Paulo Marques
- Gynecology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Francisco Falcão
- Gynecology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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19
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Bunse J, Heise M. [Rare differential diagnosis of inguinal pain and swelling in women]. Chirurg 2016; 87:973-975. [PMID: 27299752 DOI: 10.1007/s00104-016-0219-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- J Bunse
- Sana Klinikum Lichtenberg, Fanningerstr. 32, 10365, Berlin, Deutschland.
| | - M Heise
- Sana Klinikum Lichtenberg, Fanningerstr. 32, 10365, Berlin, Deutschland
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20
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Sarkar S, Panja S, Kumar S. Hydrocele of the Canal of Nuck (Female Hydrocele): A Rare Differential for Inguino-Labial Swelling. J Clin Diagn Res 2016; 10:PD21-2. [PMID: 27042529 PMCID: PMC4800595 DOI: 10.7860/jcdr/2016/16710.7284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/01/2016] [Indexed: 01/31/2023]
Abstract
The inguinal canal is traversed by the spermatic cord in men and the round ligament of uterus in women. The round ligament is attached to the uterine cornu near the origin of fallopian tube at one end and to the ipsilateral labia majora at the other. The round ligament accompanies a pouch of parietal peritoneum in the inguinal canal, which is known as 'canal of nuck'. It is analogous to the processus vaginalis in males. Incomplete obliteration of the peritoneal pouch causes indirect inguinal hernia or hydrocele of the canal of nuck; a very rare condition in women. As these types of cases are rarely seen in surgical practice we present a case of such little-known developmental disorder in a three-year-old girl. She presented with irreducible, tender right inguino-labial swelling with tachycardia simulating incarcerated inguinal hernia, which necessitates emergency surgical exploration. On exploration it was found to be an encysted hydrocele of canal of nuck; so although rare, this entity should be considered in differential diagnosis in a female child presented with inguino-labial swelling.
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Affiliation(s)
- Santanu Sarkar
- Clinical Tutor, Department of General Surgery, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - Soumyajyoti Panja
- PG Resident, Department of General Surgery, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - Sandeep Kumar
- PG Resident, Department of General Surgery, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
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21
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Heller DS. Lesions of the Round Ligament and Canal of Nuck—It Is Not Always an Inguinal Hernia: A Review. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2015.0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Debra S. Heller
- Department of Pathology & Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ
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