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Attia KH, Felemban MH, Al Boukai AA, Alfahad LA. Canal of nuck hernia containing the internal reproductive organs of both gender in a neonate with disorder of sex development: a rare case presentation. BJR Case Rep 2023. [DOI: 10.1259/bjrcr.20230003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
The combination of disorder of sex development (DSD) and canal of Nuck hernia, in which the hernial sac contains the internal reproductive organs (gonads) of both genders, is exceedingly rare. We present a unique case of a neonate who presented with ambiguous genitalia and a lump in the left inguinal region. The child underwent various radiographic procedures and hernial repair. Blood workup, karyotyping, and histopathologic analysis from gonads confirmed the diagnosis of Ovotesticular disorder of sex development. Subsequently, the child had a reconstructive vaginoplasty, and the final decision regarding gender assignment will be made after assessing mental and sexual behavior in early childhood.
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2
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Ozcan HN, Yildiz O, Ozer G, Oguz B, Haliloglu M. Many faces of torsion in pediatric female pelvis. Abdom Radiol (NY) 2022; 47:2220-2229. [PMID: 35419749 DOI: 10.1007/s00261-022-03517-1] [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] [Received: 03/17/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
Pediatric patients of various ages, from infancy through adolescence, can have ovarian torsion. Torsion may not only be confined to the ovaries but may also involve the isolated cyst, tube, and even the uterus. In this pictorial review, we review the spectrum of torsion in pediatric (from infants to adolescents) female pelvis, emphasizing imaging methods.
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Affiliation(s)
- H Nursun Ozcan
- Department of Radiology/Subdivision of Pediatric Radiology, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey.
| | - Oguzhan Yildiz
- Department of Radiology/Subdivision of Pediatric Radiology, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Gozde Ozer
- Department of Radiology/Subdivision of Pediatric Radiology, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Berna Oguz
- Department of Radiology/Subdivision of Pediatric Radiology, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Mithat Haliloglu
- Department of Radiology/Subdivision of Pediatric Radiology, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
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3
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Sadiqi J, Ezmarai M, Niazi J. Canal of Nuck incarcerated ovarian hernia with strangulation, a case report. Radiol Case Rep 2022; 17:1475-1477. [PMID: 35265243 PMCID: PMC8899120 DOI: 10.1016/j.radcr.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 10/25/2022] Open
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4
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Saguintaah M, Eulliot J, Bertrand M, Prodhomme O, Béchard N, Bolivar-Perrin J, Taleb Arrada I, Simon AH, Baud C, Millet I. Canal of Nuck Abnormalities in Pediatric Female Patients. Radiographics 2022; 42:541-558. [PMID: 35061516 DOI: 10.1148/rg.210145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A groin lump is not an uncommon condition in girls and female infants, and US plays a fundamental role in its exploration. The main pathologic conditions are related to the failure of obliteration of the canal of Nuck. Radiologists should gain a full understanding of the embryology and US anatomy of the inguinal canal before assessing this entity for the first time. An optimal age-adjusted US technique-including examinations at rest and during straining-is essential to help assess the canal of Nuck, diagnose a hernia, and analyze its content. The radiologist must be aware of the various types of hernial content depending on the patient's age, including intestinal, omental, ovarian, or tubouterine hernia, and the US features of each. Incarcerated hernias are common in girls and mostly contain an ovary. In such cases, it is crucial to screen for US signs suggestive of ovarian ischemic damage, thereby calling for urgent surgery. US can also depict a cyst or hydrocele of the canal of Nuck and its complications. Moreover, other rare pathologic conditions involving the inguinal area may be depicted at US, which helps guide appropriate treatment. US is the ideal modality for evaluating an inguinal lump in girls and female infants. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Magali Saguintaah
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Jenny Eulliot
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Margaux Bertrand
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Olivier Prodhomme
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Nancy Béchard
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Julie Bolivar-Perrin
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Ikram Taleb Arrada
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Anne-Hélène Simon
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Catherine Baud
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
| | - Ingrid Millet
- From the Department of Pediatric Radiology, Montpellier University Hospital, Montpellier, France (M.S., J.E., M.B., O.P., N.B., J.B.P., I.T.A., A.H.S., C.B., I.M.); and Institut Desbrest d'Épidémiologie et de Santé Publique (IDESP)-UA11 INSERM, Université de Montpellier, Montpellier, France (I.M.)
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5
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Wang YJ, Chen L, Zhang QL, Zhang JQ, Cui X, Zhou CM. Single-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle for incarcerated ovarian hernia in infants. BMC Surg 2022; 22:67. [PMID: 35197030 PMCID: PMC8867844 DOI: 10.1186/s12893-022-01520-3] [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: 03/20/2021] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this study was to evaluate the safety and efficacy of single-site laparoscopic extraperitoneal hernia sac ligation with an epidural needle for incarcerated ovarian hernias in infants and young children. Methods The clinical data of 38 infants with incarcerated ovarian hernias who underwent single-site laparoscopic extradural needle extraperitoneal hernia sac ligation from January 2015 to January 2018 were retrospectively analysed. Results All procedures were successfully performed using laparoscopy with no need for conversion to open surgery. The time of hospital stay was 1.30 ± 0.39 days. During hospitalization and follow-up, there were no complications, such as intestinal or bladder injury, abdominal wall vascular injury, ovarian atrophy, hernia recurrence or contralateral indirect hernia. However, three patients experienced complications, including two cases of poor healing of the umbilical incision and one case of suture granuloma. Conclusions Single-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle is a safe and feasible method for the treatment of incarcerated ovarian hernias in infants and young children. It has the advantages of minimal trauma, no scarring and good cosmetic effects.
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Affiliation(s)
- Yun-Jin Wang
- Department of Pediatric Surgery, Fujian Provincial Maternity and Children's Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Liu Chen
- Department of Pediatric Surgery, Fujian Provincial Maternity and Children's Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Qi-Liang Zhang
- Department of Pediatric Surgery, Fujian Provincial Maternity and Children's Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Jian-Qin Zhang
- Department of Pediatric Surgery, Fujian Provincial Maternity and Children's Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Xu Cui
- Department of Pediatric Surgery, Fujian Provincial Maternity and Children's Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Chao-Ming Zhou
- Department of Pediatric Surgery, Fujian Provincial Maternity and Children's Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.
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Ohkura T, Kumori K, Kawamura T, Manako J, Ishibashi S, Funabashi N, Tajima Y. Association of pediatric inguinal hernia contents with patient age and sex. Pediatr Int 2022; 64:e15193. [PMID: 35704456 DOI: 10.1111/ped.15193] [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: 07/26/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although pediatric inguinal hernia (IH) is a very common disease, systematic reviews of herniated organs are scarce. The current study aims to clarify the contents of pediatric IH using preoperative ultrasonography (US) in association with patient age, sex, and risk for developing irreducible/strangulated hernia. METHODS The medical records of pediatric IH patients who underwent inguinal US examination prior to surgery between 2014 and 2019 were reviewed. Hernia contents were categorized into four groups based on US findings: bowel, omentum, ovary with or without fallopian tube, and ascites. RESULTS A total of 524 IH lesions found in 220 men and 304 women were analyzed. The most common hernia content in patients under 12 months of age was the bowel (91.0%) in males and ovaries (89.5%) in females. The omentum became the most common herniated organ in both men (78.6%) and women (88.0%) aged 2 years and older. Emergency operations were performed in 3 patients (0.57%) due to irreducible IH, where 2 patients with irreducible ovaries, 5 and 7 months old, developed ovarian torsion and needed to undergo emergent salpingo-oophorectomy. CONCLUSIONS The contents of pediatric IH depended on patient age and sex. Herniated ovaries in infants can twist in the hernia sac and become strangulated. It is important for clinicians to expect the herniated organ and take appropriate measures in the pediatric primary care setting.
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Affiliation(s)
- Takahiro Ohkura
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Koji Kumori
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Toshihiko Kawamura
- Department of Medical Informatics, Shimane University Hospital, Izumo, Shimane, Japan
| | - Junko Manako
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Shuichi Ishibashi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Narimasa Funabashi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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7
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How embryology knowledge can help radiologists in the differential diagnosis of canal of Nuck pathologies. Radiol Med 2021; 126:910-924. [PMID: 33954897 DOI: 10.1007/s11547-021-01361-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
The Canal of Nuck (CN) is an anatomical structure which is often forgotten. It is the female equivalent of the male processus vaginalis and corresponds to a protrusion of parietal peritoneum that extends from the inguinal canal to labia majora. Radiologists rarely encounter patients with pathology of CN, especially in adult population. It is well known that CN diseases can occur in paediatric patient (especially younger than 5 years of age) and they are associated to high morbidity (for example ovarian hernia with high risk of incarceration and torsion). The aim of our work is to review embryology, anatomy and pathologies of the CN thanks to a multi modal approach-ultrasound (US), Computed Tomography (CT) and Magnetic Resonance imaging (MRI)-to make radiologists more aware of such conditions and guarantee a prompt and correct diagnosis not only in paediatric patients but also in the adult population.
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8
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Amreen S, Yaseen Y. Ovarian inguinal hernia. J Ultrason 2020; 20:e226-e227. [PMID: 33365162 PMCID: PMC7705479 DOI: 10.15557/jou.2020.0039] [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: 05/28/2020] [Accepted: 07/03/2020] [Indexed: 11/22/2022] Open
Abstract
Indirect inguinal hernia is a common congenital abnormality in children. In female infants, herniation of the ovaries, fallopian tubes and uterus has been reported. Herniation of the ovaries is a rare congenital condition that may be complicated by strangulation, torsion, and infertility. A 6-week-old female infant presented with visible swelling in the right inguinal region. This case highlights the utility of ultrasonography as a cheap and easily available imaging technique that can be used for the characterization of the hernial contents, and guide the management, further accentuated by the use of color Doppler imaging, of this subtle but crucial entity.
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Affiliation(s)
- Saika Amreen
- Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Soura, India
| | - Yawar Yaseen
- Medical Officer, Directorate of Health Services, Kashmir, India
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9
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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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10
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Kumar D, Maheshwari S, Rajesh U, Grewal D, Maria V. Herniation of the uterus, ovaries and fallopian tubes into the canal of Nuck in a 4-month-old child: A rare entity. SA J Radiol 2020; 24:1935. [PMID: 33240543 PMCID: PMC7670020 DOI: 10.4102/sajr.v24i1.1935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/20/2020] [Indexed: 11/04/2022] Open
Abstract
Partial or complete failure of obliteration of the processus vaginalis in the female results in the formation of a potential space known as the canal of Nuck, into which various organs and/or collections can herniate. A 4-month-old female presented with a left labial mass related to herniation of the uterus, ovaries and fallopian tubes through the canal of Nuck. Early diagnosis is important as there is a high risk of ovarian torsion and incarceration.
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Affiliation(s)
- Dharmendra Kumar
- Department of Radiodiagnosis and Imaging, Armed Forces Medical College, Pune, India
| | - Saurabh Maheshwari
- Department of Radiodiagnosis and Imaging, Armed Forces Medical College, Pune, India
| | - Uddandam Rajesh
- Department of Radiodiagnosis and Imaging, Armed Forces Medical College, Pune, India
| | - Darshan Grewal
- Department of Radiodiagnosis and Imaging, Armed Forces Medical College, Pune, India
| | - Vibhuti Maria
- Department of Radiodiagnosis and Imaging, Armed Forces Medical College, Pune, India
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11
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Paediatric groin lesions: Imaging findings. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Arango-Díaz A, Trujillo-Ariza MV, Liñares-Paz MM, Baleato-González S, García-Palacios M. Pediatric groin lesions: imaging findings. RADIOLOGIA 2020; 62:188-197. [PMID: 32165019 DOI: 10.1016/j.rx.2020.01.005] [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: 10/09/2019] [Revised: 01/02/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The groin is a complex anatomic region that has traditionally been ignored by radiologists because most lesions can be diagnosed from clinical data and physical examination. Nevertheless, ultrasound examinations of the groin are increasingly being requested to confirm injury or to resolve diagnostic uncertainty. On the other hand, some conditions involving the groin are found only in pediatric patients. This article describes the key imaging findings in pediatric groin injuries, placing special emphasis on the ultrasound appearance. CONCLUSIONS Knowledge about conditions that can affect the groin in pediatric patients and the key imaging findings associated with them helps improve the diagnostic performance of ultrasound.
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Affiliation(s)
- A Arango-Díaz
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). Santiago de Compostela, A Coruña, España.
| | - M V Trujillo-Ariza
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). Santiago de Compostela, A Coruña, España
| | - M M Liñares-Paz
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). Santiago de Compostela, A Coruña, España
| | - S Baleato-González
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). Santiago de Compostela, A Coruña, España
| | - M García-Palacios
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). Santiago de Compostela, A Coruña, España
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13
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Thomas AK, Thomas RL, Thomas B. Canal of Nuck Abnormalities. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:385-395. [PMID: 31378959 DOI: 10.1002/jum.15103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/01/2019] [Accepted: 07/07/2019] [Indexed: 06/10/2023]
Abstract
Canal of Nuck abnormalities are underrecognized causes of labial masses with potential adverse outcomes. The 2 main categories of canal of Nuck abnormalities are hernias and hydroceles. There are 3 types of canal of Nuck hydroceles: communicating, encysted, and bilocular. Canal of Nuck hernia contents vary, but those containing ovaries need urgent medical attention because of an increased risk of ischemia. Ultrasound can establish a definite diagnosis in all cases. This article reviews the embryologic characteristics, anatomy, pathologic characteristics, and imaging features of these abnormalities while providing a clear pictorial depiction of various unique hernias and hydroceles seen with this entity.
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Affiliation(s)
- Anna Kalathil Thomas
- University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
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14
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Chan D, Kwon JK, Lagomarsino EM, Veltkamp JG, Yang MS, Pfeifer CM. Canal of Nuck hernias. Acta Radiol Open 2019; 8:2058460119889867. [PMID: 31839990 PMCID: PMC6902399 DOI: 10.1177/2058460119889867] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/31/2019] [Indexed: 11/18/2022] Open
Abstract
The canal of Nuck, caused by the failed closure of the processus vaginalis in the female, is the continued outpouching of parietal peritoneum through the inguinal canal to the labia majora. Disorders of the canal of Nuck include hernia and hydrocele. Some canal of Nuck hernias, especially of the ovary, may result in emergent complications such as incarceration, strangulation, and ovarian torsion. Knowledge of canal of Nuck disorders and prompt diagnosis are important to avoid serious complications. Imaging, especially ultrasound, is essential for timely diagnosis, leading to appropriate management and better patient care.
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Affiliation(s)
- Donald Chan
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeannie K Kwon
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Jennifer G Veltkamp
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mary S Yang
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Cory M Pfeifer
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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15
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Kurobe M, Harada A, Sugihara T, Baba Y, Hiramatsu T, Ohashi S, Otsuka M. Management of inguinal hernia with prolapsed ovary in very low birthweight infants during neonatal intensive care unit hospitalisation. J Paediatr Child Health 2019; 55:1357-1360. [PMID: 30828894 DOI: 10.1111/jpc.14421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/13/2019] [Accepted: 02/10/2019] [Indexed: 12/01/2022]
Abstract
AIM Prolapsed ovary (PO) in an inguinal hernia (IH) may cause torsion and infarction; however, the management of IH with PO in very low birthweight (VLBW) infants during neonatal intensive care unit (NICU) hospitalisation remains inconsistent. METHODS The medical records of 47 IHs in 30 VLBW infants during NICU hospitalisation between 2008 and 2017 were reviewed retrospectively. RESULTS Of the 47 IHs, PO was diagnosed in 18 (38.3%). Post-natal age and body weight at diagnosis of IH with PO were 71 (44-172) days and 2120 (1305-2965) g, respectively. Seventeen IHs with PO underwent surgery for correction electively just before discharge from the NICU at the age and body weight of 94 (51-187) days and 2645 (2340-2945) g, respectively. Therefore, the time interval between diagnosis and surgery was 15 (7-90) days. There was no torsion of ovary before surgery and no postoperative complications, including apnoea and recurrence. CONCLUSIONS The high incidence of IH with PO in VLBW infants during NICU hospitalisation was confirmed in this study. Under careful observation, elective IH repair just before discharge from the NICU could be one acceptable option for the management of IH with PO in VLBW infants during NICU hospitalisation to prevent torsion and infarction of ovary.
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Affiliation(s)
- Masashi Kurobe
- Department of Pediatric Surgery, Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Atsushi Harada
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuro Sugihara
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Baba
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomomasa Hiramatsu
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinsuke Ohashi
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiko Otsuka
- Department of Surgery, Kawaguchi Municipal Medical Center, Saitama, Japan
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16
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Abstract
BACKGROUND Inguinal hernia in girls is a very rare condition. The cause of this pathology is incomplete closure of the processus vaginalis of the peritoneum, in girls named the canal of Nuck. Failed obliteration of this canal could result in hernia or hydrocele. Also less frequent findings, such as uterus herniated to the canal, were observed. OBJECTIVE The purpose of this study was to describe the possible findings in female inguinal hernias and its ultrasound appearance. METHODS Thirty-five patients with surgically confirmed hernias of the canal of Nuck were identified at our institution between January 2007 and November 2015. All the patients underwent ultrasonography before surgery. RESULTS In 14 cases, there was hydrocele of the canal of Nuck. In 9 cases, intestinal hernia was found. In 10 patients, the hernia content appeared as mass-containing cysts and was confirmed at surgery as ovary. In 1 patient, the ovary was herniated together with uterus. In 1 patient, atypical hypoechoic lesion was found, which turned out to be angiofibrolipoma. In all patients, ultrasound diagnosis was confirmed by surgery. CONCLUSIONS Ultrasound examination performed with high-frequency transducer is an examination of choice in female patients with pathological mass in inguinal region.
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17
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Ravikanth R, Kamalasekar K. Left Ovary-Containing Hernia of the Canal of Nuck and Right Inguinal Hernia with Small Bowel Loops in a 12-Day-Old Newborn Girl: A Rarity. J Med Ultrasound 2019; 27:158-159. [PMID: 31867182 PMCID: PMC6905265 DOI: 10.4103/jmu.jmu_96_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/28/2018] [Indexed: 11/04/2022] Open
Affiliation(s)
- Reddy Ravikanth
- Department of Radiology, Holy Family Hospital, Thodupuzha, Kerala, India
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18
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Amini R, Baker N, Woolridge DP, Echeverria AB, Amini A, Adhikari S. Emergency department diagnosis of an ovarian inguinal hernia in an 11-year-old female using point-of-care ultrasound. World J Emerg Med 2018; 9:291-293. [PMID: 30181799 DOI: 10.5847/wjem.j.1920-8642.2018.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Richard Amini
- Department of Emergency Medicine, The University of Arizona, Tucson, AZ, USA
| | - Nicola Baker
- Department of Emergency Medicine, Northwest Medical Center, Tucson, AZ, USA
| | - Dale P Woolridge
- Department of Emergency Medicine, The University of Arizona, Tucson, AZ, USA
| | | | | | - Srikar Adhikari
- Department of Emergency Medicine, The University of Arizona, Tucson, AZ, USA
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19
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Canal of Nuck hernia containing pelvic structures presenting as a labial mass. Radiol Case Rep 2018; 13:534-536. [PMID: 29849852 PMCID: PMC5966625 DOI: 10.1016/j.radcr.2018.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 02/03/2018] [Indexed: 11/22/2022] Open
Abstract
Although rare, canal of Nuck hernias containing pelvic structures or peritoneal contents are an important differential consideration in the pediatric setting of a palpable labial mass. This diagnosis should be considered early as there is a high rate of associated ovarian torsion in the setting of incarcerated hernias containing ovaries. Early sonographic evaluation is crucial to establish the diagnosis. We report an extremely rare case of a 2-month-old who presented with right labial swelling due to a canal of Nuck hernia containing the uterus, the ipsilateral ovary, and the fallopian tube.
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20
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Nasser H, King M, Rosenberg HK, Rosen A, Wilck E, Simpson WL. Anatomy and pathology of the canal of Nuck. Clin Imaging 2018; 51:83-92. [PMID: 29448124 DOI: 10.1016/j.clinimag.2018.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/17/2018] [Accepted: 02/02/2018] [Indexed: 11/26/2022]
Abstract
The canal of Nuck is the female equivalent of the processus vaginalis in the male but is less well known than its male counterpart. It is a rare entity not commonly encountered by radiologists, particularly in the adult population. Knowledge of the embryology and anatomy of the canal of Nuck is essential for identification of the various pathologic conditions that may occur in this location. Moreover, radiologists should be familiar with this entity to compose an appropriate and thorough differential diagnosis of a labial mass/swelling. In this review, we discuss both the anatomy and the more common pathology that can be encountered within it.
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Affiliation(s)
- Hussein Nasser
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Michael King
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | | | - Ally Rosen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Eric Wilck
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - William L Simpson
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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21
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Canal of Nuck hernia: a multimodality imaging review. Pediatr Radiol 2017; 47:893-898. [PMID: 28444423 DOI: 10.1007/s00247-017-3853-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/11/2017] [Accepted: 03/28/2017] [Indexed: 01/28/2023]
Abstract
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.
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22
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The challenging sonographic inguinal canal evaluation in neonates and children: an update of differential diagnoses. Pediatr Radiol 2017; 47:461-472. [PMID: 27832304 DOI: 10.1007/s00247-016-3706-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 07/24/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Abstract
Bulging of the inguinal region is a frequent complaint in the pediatric population and sonographic findings can be challenging for radiologists. In this review we update the sonographic findings of the most common disorders that affect the inguinal canal in neonates and children, with a focus on the processus vaginalis abnormalities such as congenital hydroceles, indirect inguinal hernias and cryptorchidism, illustrated with cases collected at a quaternary hospital during a 7-year period. We emphasize the importance of correctly classifying different types of congenital hydrocele and inguinal hernia to allow for early surgical intervention when necessary. We have systematically organized and illustrated all types of congenital hydrocele and inguinal hernias based on embryological, anatomical and pathophysiological findings to assist readers in the diagnosis of even complex cases of inguinal canal ultrasound evaluation in neonates and children. We also present rare diagnoses such as the abdominoscrotal hydrocele and the herniation of uterus and ovaries into the canal of Nuck.
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Park HR, Park SB, Lee ES, Park HJ. Sonographic evaluation of inguinal lesions. Clin Imaging 2016; 40:949-55. [PMID: 27209238 DOI: 10.1016/j.clinimag.2016.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 04/24/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
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24
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Choi KH, Baek HJ. Incarcerated ovarian herniation of the canal of Nuck in a female infant: Ultrasonographic findings and review of literature. Ann Med Surg (Lond) 2016; 9:38-40. [PMID: 27408712 PMCID: PMC4925906 DOI: 10.1016/j.amsu.2016.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction Inguinal hernia with containing the ovary presenting as a palpable groin mass is an uncommon congenital condition, and it may cause complications such as strangulation, torsion, and infertility. We present a case of ovarian herniation into inguinal canal with sonographic findings. Presentation of case A 15-day-old infant girl visited our hospital with the complaints of palpable mass in the right groin. On physical examination, a palpable non-movable mass was found in the right inguinal region, and it was irreducible. During sonographic examination, a well-circumscribed solid mass containing small cysts was found. Then, oophorectomy with high inguinal ligation was performed, and the patient was doing well after surgery. Discussion The canal of Nuck is an abnormal patent pouch of the parietal peritoneum extending to the round ligament of the uterus into the labia majora through the inguinal ring. When this canal obliterates incompletely, inguinal herniation of ovary or hydrocele occur in the female children. In the clinical practice, ovarian herniation should be differentiated from a hernia containing intestine, fat, fluid, or lymph nodes. Therefore, a careful sonographic evaluation is mandatory to make an accurate diagnosis in female infants with palpable inguinal mass. Conclusion Ultrasound (US) with color Doppler US can be helpful to the diagnosis of ovarian herniation through the canal of Nuck and hernia-related complications. The canal of Nuck is an abnormal patent pouch of the parietal peritoneum extending to the round ligament of the uterus into the labia majora through the inguinal ring into the inguinal canal. Incomplete obliteration of canal of Nuck can result in either an inguinal hernia or a hydrocoele in female children. Awareness of ovarian herniation through the canal of Nuck and its embryologic mechanisms can be helpful for the identification of this disease and the prevention of its unexpected complication in clinical practice.
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Affiliation(s)
- Kwang Ho Choi
- Research Institute for Convergence of Biomedical Science and Technology, Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Republic of Korea
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Muthiyal S, Kini V, Kounsal A, Ibrahim AA. Rarity in conspicuity-Ultrasound diagnosis of sliding left inguinal hernia through canal of Nuck with uterus, fallopian tubes and ovaries. Eur J Radiol Open 2016; 3:35-7. [PMID: 27069977 PMCID: PMC4811852 DOI: 10.1016/j.ejro.2016.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 11/20/2022] Open
Abstract
We present a case of a one month old female infant who presented with left inguinal swelling. She was prematurely born at 32 weeks of gestational age. Preoperative ultrasound showed features of sliding indirect inguinal hernia with both ovaries, fallopian tubes and uterus; which were also evident per operatively. Patient underwent successful hernia repair and uneventful post-operative period. Patient is on follow up currently. In conclusion, we attempt to highlight the exiguous prevalence of inguinal hernia with uterus, fallopian tubes and ovaries; which has been sparsely reported in the literature and also the importance of preoperative of sonography.
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Affiliation(s)
| | | | - Avin Kounsal
- Dept. of Radiology, Hamad General Hospital, Doha, Qatar
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