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Patel R, Shames A, Sarkodieh J. Ultrasound features of benign paediatric lumps: radiology-pathology correlation. Clin Radiol 2024; 79:255-262. [PMID: 38320943 DOI: 10.1016/j.crad.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/12/2023] [Accepted: 12/31/2023] [Indexed: 02/08/2024]
Abstract
Ultrasonography is an appropriate first-line imaging technique for the characterisation of paediatric lumps, given its relative accessibility and absence of radiation exposure. Together with a thorough history and examination, ultrasonography can help to distinguish benign lesions from malignancy. It can also aid further characterisation of benign lesions to inform onward investigation and management. This review features the evaluation of common benign paediatric lumps together with their characteristic sonographic features, following correlation with histopathology results or clinical follow-up.
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Affiliation(s)
- R Patel
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK.
| | - A Shames
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK
| | - J Sarkodieh
- Whipps Cross Hospital, Barts Health NHS Trust, Whipps Cross Road, London, UK
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Venkateswaran R, Ansari K, Bhondve S, Bhandarwar A, Padekar HD, Dandge S, Dashputra AV. Laparoscopic Versus Open Surgical Management of Hydrocele of the Canal of Nuck: A Retrospective Analysis of 20 Cases. Cureus 2024; 16:e56584. [PMID: 38646218 PMCID: PMC11031193 DOI: 10.7759/cureus.56584] [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: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION Hydrocele of the canal of Nuck is a condition that arises due to incomplete obliteration of the processus vaginalis or an abnormal outpouching from the round ligament during fetal development. It usually presents as a painless, rarely painful, groin swelling. The definitive diagnosis for this condition is magnetic resonance imaging. Various management options have been proposed for this condition, including open surgery, transabdominal preperitoneal approach, totally extraperitoneal approach, and a combination of laparoscopic and open surgery. The present study highlights the benefits of the transabdominal preperitoneal approach when compared with the open anterior approach and addresses the intraoperative challenges faced during laparoscopic surgery. MATERIALS AND METHODS The study is a retrospective study inclusive of 20 patients who underwent surgery for the hydrocele of the canal of Nuck from June 2019 to December 2023. Case records of patients were studied for information such as demographic features, type of pathology, the surgery performed, intraoperative challenges encountered, operative time, duration of hospital stay, scores from the visual analog scale pain assessment chart at various intervals, and time taken to return to work. The variables were documented and statistically analyzed. RESULTS The average age group of the study population was 27.8 ± 8.34 years. Of the 20 patients, 10 had undergone a transabdominal preperitoneal approach (Group A), and 10 had undergone an open anterior approach (Group B). Eleven out of 20 patients had an associated inguinal hernia, of which three were identified preoperatively and eight were identified incidentally during surgery. The mean operative time of Group A cases was 97.95 ± 7.54 minutes, while it was 66.3 ± 6.20 minutes for Group B cases. The Mann-Whitney U test showed a statistically significantly lesser operative time for Group B than for Group A (p-value < 0.001). The duration of hospital stays was comparable for the two groups with no significant difference (two days versus 3.8 ± 3.08 days, respectively). When the difference in the means of time taken to return to normal work was compared using the Mann-Whitney U test between Group A and B (6.1 ± 0.87 days and 11.2 ± 1.81 days, respectively), a statistically significant early return to normal work in the former group (p-value = 0.001) was revealed. Similarly, the Mann-Whitney U test when used to compare the median postoperative pain score of both groups at 12-24 hours, 48-72 hours, seven days, and three months showed a significantly lesser pain score among patients of Group A at all intervals (p-value < 0.001, p-value = 0.005, p-value = 0.005, p-value < 0.001, respectively). The incidence of intraoperative challenges, sero-hematoma, and surgical site infection were insignificant in comparison. CONCLUSION The transabdominal preperitoneal approach for the hydrocele of the canal of Nuck is ideal as it offers excellent intraoperative delineation of pathology and postoperative outcomes. Prophylactic placement of a mesh in all cases can help prevent a future occurrence of inguinal hernia in these cases.
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Affiliation(s)
- Rajalakshmi Venkateswaran
- General Surgery, Grant Government Medical College and Sir JJ (Jamshedjee Jeejeebhoy) Group of Hospitals, Mumbai, IND
| | - Kashif Ansari
- General Surgery, Grant Government Medical College and Sir JJ (Jamshedjee Jeejeebhoy) Group of Hospitals, Mumbai, IND
| | - Supriya Bhondve
- General Surgery, Grant Government Medical College and Sir JJ (Jamshedjee Jeejeebhoy) Group of Hospitals, Mumbai, IND
| | - Ajay Bhandarwar
- General Surgery, Grant Government Medical College and Sir JJ (Jamshedjee Jeejeebhoy) Group of Hospitals, Mumbai, IND
| | - Harshal D Padekar
- General Surgery, Grant Government Medical College and Sir JJ (Jamshedjee Jeejeebhoy) Group of Hospitals, Mumbai, IND
| | - Snehal Dandge
- General Surgery, Grant Government Medical College and Sir JJ (Jamshedjee Jeejeebhoy) Group of Hospitals, Mumbai, IND
| | - Amit V Dashputra
- General Surgery, Grant Government Medical College and Sir JJ (Jamshedjee Jeejeebhoy) Group of Hospitals, Mumbai, IND
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Khadim B, AlNuaimi D, Abdulghaffar S, AlKetbi R. Hydrocele of the canal of Nuck: a rare differential diagnosis for an inguinal hernia. J Ultrason 2024; 24:20240007. [PMID: 38419838 PMCID: PMC10897368 DOI: 10.15557/jou.2024.0007] [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] [Received: 05/04/2023] [Accepted: 06/12/2023] [Indexed: 03/02/2024] Open
Abstract
Hydrocele of the canal of Nuck is a rare condition which is commonly misdiagnosed as an inguinal hernia due to the unfamiliarity of clinicians with this pathology. There are three different types of hydrocele of the canal of Nuck, with type 1 being the most common, typically presenting as a unilocular cystic lesion with no communication with the peritoneal cavity. We present a case of a two-month-old female patient with an enlarging inguinal swelling raising the suspicion for an inguinal hernia or lymphadenopathy, with sonographic imaging revealing a fluid collection in the canal of Nuck, suggestive of a hydrocele. Diagnostic radiology plays a crucial role in the initial diagnosis of a canal of Nuck hydrocele, and ultrasound is considered the modality of choice for early diagnosis differentiating it from other causes of inguinal swelling.
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Affiliation(s)
- Badreya Khadim
- Department of Radiology, Dubai Health Authority, Dubai, United Arab Emirates
| | - Dana AlNuaimi
- Department of Health, Abu Dhabi, United Arab Emirates
| | | | - Reem AlKetbi
- Department of Radiology, Dubai Health Authority, Dubai, United Arab Emirates
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Elsayed MI, Ibrahim R, Khatri A, Palliyil M. A Canal of Nuck Cyst Presented as a Femoral Hernia: A Rare Case Report With Diagnostic Dilemma. Cureus 2024; 16:e51908. [PMID: 38196983 PMCID: PMC10775744 DOI: 10.7759/cureus.51908] [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: 01/08/2024] [Indexed: 01/11/2024] Open
Abstract
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.
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Affiliation(s)
| | - Rashid Ibrahim
- General Surgery, Stepping Hill Hospital, Manchester, GBR
| | - Amulya Khatri
- General Surgery, Stepping Hill Hospital, Manchester, GBR
| | - Madan Palliyil
- General Surgery, Stepping Hill Hospital, Manchester, GBR
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5
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Singh A, Chauhan E, Kalantri A, Gupta S. Hydrocele and endometriosis of the canal of Nuck in two adults: a look at the imaging features. BMJ Case Rep 2023; 16:e255970. [PMID: 37852666 PMCID: PMC10603436 DOI: 10.1136/bcr-2023-255970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
We present a report of two adult females who presented to the surgery clinic at different time frames in our hospital with a swelling in the inguinal region. The swelling was painful for one of our patients. The first patient was evaluated with a contrast-enhanced CT and an MRI, while the second patient underwent a ultrasonography and an MRI. Imaging revealed the structure to be cystic in nature and confirmed the diagnosis as a hydrocele of the canal of Nuck in both patients. Our second patient was also found to have concomitant endometriosis, with internal septations seen in the hydrocele. Aspiration revealed altered blood with haemosiderin deposition, which established a diagnosis of endometriosis of the canal of Nuck. The first patient underwent excision, while the second patient refused a surgical approach and opted for medical management for endometriosis.
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Affiliation(s)
- Anmol Singh
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Ekta Chauhan
- Department of Radiology, Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Amrita Kalantri
- Department of Radiology, Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Sanjay Gupta
- General Surgery, Government Medical College and Hospital, Chandigarh, Chandigarh, India
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Egbuchulem K, Akinboyewa B, Onwurah C. NON-COMMUNICATING HYDROCOELE OF THE CANAL OF NUCK: A RARE FINDING IN A RURAL-DWELLING NIGERIAN WOMAN. Ann Ib Postgrad Med 2023; 21:90-93. [PMID: 38298350 PMCID: PMC10811713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/30/2023] [Indexed: 02/02/2024] Open
Abstract
Background The surgical condition termed hydrocoele of the canal of Nuck is one of the rarest clinical entities in the female group. It occurs due to the failure of obliteration of the derivative of the peritoneum, the processus vaginalis. It usually presents with painless inguinal swellings and is sometimes associated with features of intestinal obstruction if there is hernia coexisting with it that has become obstructed. Abdominopelvic ultrasonography and magnetic resonance imaging provide the basis for diagnosis, where these imaging modalities are available. However, a definite diagnosis may only be made during surgery. Definitive treatment includes groin exploration and excision of the cyst with high ligation of the neck of the sac up to the peritoneal pouch, along with repair of the inguinal hernia, if present. Case Presentation We present a rare case of a 34-year-old woman who presented with clinical features of a left inguinolabial swelling post-surgery, and diagnosed as left recurrent irreducible inguinal hernia. Intraoperatively, a cystic swelling with serous collection was observed. She had hydrocoelectomy and repair of the left groin surgical wound. Conclusion Hydrocoele of the canal of Nuck may be misdiagnosed as inguinal hernia because of its rarity, lack of adequate knowledge regarding the entity and paucity of literature on the subject matter. This report is to furthermore increase our level of awareness of this condition especially after a previous groin surgery.
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Affiliation(s)
- K.I Egbuchulem
- Division of Paediatric Surgery, Department of Surgery, University College Hospital, Ibadan
| | - B.A. Akinboyewa
- Department of Anaesthesia, University College Hospital, Ibadan
| | - C.O Onwurah
- Final Year Medical Student, Faculty of Clinical Sciences, University of Ibadan, Ibadan
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Hydrocele of the Nuck canal. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2022.102502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Bazuaye-Ekwuyasi E, Odogwu-Hall O, Bushey H, Camacho A, Bhargava P. Multimodality imaging features of Canal-of-Nuck hydrocele in adults. Clin Imaging 2022; 92:101-108. [DOI: 10.1016/j.clinimag.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/28/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022]
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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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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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11
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Baig Z, Hunka N, Gaboury J. Surgical treatment of a canal of Nuck cyst presenting as a femoral hernia: An unusual case report. Int J Surg Case Rep 2021; 87:106435. [PMID: 34619454 PMCID: PMC8502700 DOI: 10.1016/j.ijscr.2021.106435] [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: 09/08/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 10/30/2022] Open
Abstract
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.
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Affiliation(s)
- Zarrukh Baig
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada.
| | - Nolan Hunka
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Jeffrey Gaboury
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada; College of Medicine, University of Saskatchewan, Saskatoon, Canada
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12
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Baral S, Bajracharya P, Thapa N, Chhetri RK. Bilateral Hydrocele of the Canal of Nuck: A Rare Presentation in an Adult Female. Int Med Case Rep J 2020; 13:313-316. [PMID: 32801942 PMCID: PMC7410395 DOI: 10.2147/imcrj.s260367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022] Open
Abstract
Hydrocele of the canal of Nuck is one of the rarest clinical entities in the female population. It occurs due to the failure of obliteration of the processus vaginalis, which is the extension of the parietal peritoneum. Hydrocele may be seen, along with associated inguinal hernia. It usually presents with painless inguinal unilateral or bilateral swellings, and is sometimes associated with features of intestinal obstruction if the hernia becomes incarcerated or obstructed. Ultrasonography of the abdomen and pelvis and magnetic resonance imaging provide the diagnosis, if these imaging modalities are available; however, definite diagnosis may only be made during surgery. Definitive treatment includes open/laparoscopic excision of the cyst with high ligation of the neck up to the peritoneal pouch, along with repair of the inguinal hernia, if present. We present a rare case of a 25-year-old woman who presented with bilateral inguinolabial swelling, clinically diagnosed as bilateral irreducible inguinal hernia. Intraoperatively, polycystic swelling with serous content was observed along with associated indirect inguinal hernia containing omentum on the left side. She was treated with removal of the cystic component of the bilateral canal and tissue repair of the left indirect inguinal hernia. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/XeM2MeLkQko
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Affiliation(s)
- Suman Baral
- Department of Surgery, Lumbini Medical College and Teaching Hospital, Palpa, Tansen, Nepal
| | - Pujan Bajracharya
- Department of Surgery, Lumbini Medical College and Teaching Hospital, Palpa, Tansen, Nepal
| | - Neeraj Thapa
- Department of Surgery, Lumbini Medical College and Teaching Hospital, Palpa, Tansen, Nepal
| | - Raj Kumar Chhetri
- Department of Surgery, Lumbini Medical College and Teaching Hospital, Palpa, Tansen, Nepal
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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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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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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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Brainwood M, Beirne G, Fenech M. Persistence of the processus vaginalis and its related disorders. Australas J Ultrasound Med 2020; 23:22-29. [PMID: 34760578 DOI: 10.1002/ajum.12195] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The processus vaginalis is a blind-ended evagination of the abdominal wall that develops during fetal life and typically undergoes obliteration in early life. Persistence of the processus vaginalis is associated with a number of pathologies including congenital indirect inguinal hernias, communicating hydroceles, funicular and encysted hydroceles, canal of Nuck cysts, and acquired undescended testis. Whilst all are detectable sonographically, there is little educational material relevant to the field of ultrasound with much of the literature directed at surgical and primary care physicians. Furthermore, within the literature there is a lack of consensus on several areas including the anatomy and embryology of the processus vaginalis and the mechanisms behind its obliteration. As such the objective of this paper is to distil the information regarding the persistent processus vaginalis as it is relevant to ultrasound and in doing so address the literature gap for sonographers and sonologists. The anatomy and embryology of the persistent processus vaginalis will be discussed including causative mechanisms for anomalies with their sonographic appearance highlighted.
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Affiliation(s)
- Michelle Brainwood
- Department of Ultrasound Qscan Radiology Clinics College Junction 2-12 Wagner Road Clayfield Queensland 4011 Australia
| | - Geraldene Beirne
- Locum Senior Sonographer Matraville New South Wales 2036 Australia
| | - Michelle Fenech
- School of Health, Medical and Applied Sciences Central Queensland University 160 Ann Street Brisbane Queensland 4000 Australia
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17
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Karapolat B, Ata Korkmaz HA, Kocak G, Bulut E. Image of the month: cyst of the canal of Nuck. Acta Chir Belg 2018; 118:138-140. [PMID: 29433378 DOI: 10.1080/00015458.2018.1438566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Banu Karapolat
- Department of General Surgery, Kanuni Training and Research Hospital, Trabzon, Turkey
| | | | - Gulgun Kocak
- Department of Pathology, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Eser Bulut
- Department of Radiology, Kanuni Training and Research Hospital, Trabzon, Turkey
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Okoshi K, Mizumoto M, Kinoshita K. Endometriosis-associated hydrocele of the canal of Nuck with immunohistochemical confirmation: a case report. J Med Case Rep 2017; 11:354. [PMID: 29262869 PMCID: PMC5738847 DOI: 10.1186/s13256-017-1522-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 11/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background The canal of Nuck is an embryological vestige of the processus vaginalis, and presents a potential site for endometriosis seeding. Hydroceles in this region are a rare cause of inguinal swelling in females. In addition, endometriosis localized to the canal of Nuck is exceedingly rare. Case presentation A 44-year-old Japanese woman presented with a painful mass overlying her right pubis. She underwent surgery to completely excise the mass. During surgery, division of the external oblique aponeurosis revealed a cyst that occupied the inguinal canal and it adhered to the transverse fascia, inguinal ligament, and pubic bone. The cyst was dissected from the round ligament, and the defect in the internal inguinal ring was repaired and reinforced with mesh. On macroscopic examination, the cyst had a heterogeneous fibrous aspect with dark brown inclusions. Microscopic examination revealed that the cyst was tortuous, lined by mesothelial-like cells, and accompanied by partial subcapsular hemorrhage. Endometrium-like tissue was observed in the cystic wall. Immunohistochemical staining for podoplanin confirmed the mesothelial origin of the cyst-lining cells. The epithelial cells and stromal cells were positive for estrogen receptors. Conclusions In this case of an endometriosis-associated hydrocele of the canal of Nuck, the mesothelial origin of the cyst-lining cells and endometriosis were confirmed by positive immunohistochemical staining for podoplanin and estrogen receptors, respectively. We determined that hydrocele resection and reinforcement of the anterior inguinal canal wall (if necessary) are appropriate treatments for this condition.
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Affiliation(s)
- Kae Okoshi
- Department of Surgery, The Japan Baptist Hospital, 47 Yamanomoto-cho, Kitashirakawa, Sakyo-ku, Kyoto, 606-8273, Japan.
| | - Masaki Mizumoto
- Department of Surgery, The Japan Baptist Hospital, 47 Yamanomoto-cho, Kitashirakawa, Sakyo-ku, Kyoto, 606-8273, Japan
| | - Koichi Kinoshita
- Department of Surgery, The Japan Baptist Hospital, 47 Yamanomoto-cho, Kitashirakawa, Sakyo-ku, Kyoto, 606-8273, Japan
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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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