A Canal of Nuck Cyst Presented as a Femoral Hernia: A Rare Case Report With Diagnostic Dilemma

A cyst of the canal of Nuck is an uncommon disorder in females. It results from the failure of obliteration of the peritoneal fold that runs along the round ligament. This case report details a unique and rare presentation of a 38-year-old female who presented with a right groin swelling. Although her preoperative images showed only the right canal of the Nuck cyst, the intraoperative diagnosis was established as a femoral hernia containing a canal of the Nuck cyst. She underwent an elective cyst excision with repair of the femoral hernia. She had an uneventful post-operative recovery. A femoral hernia that contains a cyst of the canal of Nuck is a rare manifestation of this uncommon condition. The most effective treatment options are surgical cyst excision and repair of the femoral hernia.

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

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.

Cyst and endometriosis of the canal of Nuck: rare differentials for a female groin mass

Cyst of the canal of Nuck is a rare abnormality of the female inguinal canal that can present similarly to a hernia. If incompletely obliterated, the patent canal of Nuck may predispose to an inguinal hernia or hydrocele due to direct communication with the abdominal cavity. Such defects are normally detected and repaired in early childhood but can also present later in adult life. We report the case of a 44-year-old woman who presents with a fluctuant, mobile and irreducible left-sided groin mass. Ultrasound of the groin identified a cystic structure in the canal of Nuck. The patient underwent successful open herniorrhaphy with excision of the cyst and mesh repair of the inguinal canal. Subsequent histopathological examination also revealed concurrent endometriosis of the canal of Nuck. A systematic approach to differential diagnoses for a female groin mass, further investigations and management are discussed.

Surgical treatment of a canal of Nuck cyst presenting as a femoral hernia: An unusual case report

INTRODUCTION AND IMPORTANCE

A canal of Nuck cyst forms because of a patent peritoneal fold evaginating through the inguinal canal in a female patient. It is a rare diagnosis because the canal often obliterates within the first year of a female patient's life. A persistent canal of Nuck may cause indirect inguinal hernias, or form hydroceles, termed canal of Nuck cysts. Here we report the first case of a canal of Nuck cyst discovered to be evaginating through the femoral canal.

CASE PRESENTATION

A 70-year-old female patient initially presented with a symptomatic groin mass, and a suspected inguinal hernia on pre-operative ultrasound. Intraoperatively, she was found to have a canal of Nuck cyst terminating within the femoral canal. This was successfully repaired using a modified McVay approach, and approximation of the internal inguinal ring. She performed well post-operatively with no signs of recurrence at her six-month follow-up.

CLINICAL DISCUSSION

This case report serves to highlight the canal of Nuck cyst, a rare embryologic remnant, and the first literature-reported femoral canal of Nuck cyst. We re-affirm the diagnostic unreliability of ultrasound imaging in the workup of groin hernias. Furthermore, we describe surgical techniques to repair a canal of Nuck cyst found within the femoral canal.

CONCLUSION

To the best of our knowledge, no prior literature reports a canal of Nuck cyst presenting as a femoral hernia. This rare diagnosis may be encountered in common operations and is amenable to definitive repair using traditional hernia repair techniques.