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

Laparoscopic Approach To Treat a Hydrocele of the Canal of Nuck: A Case Report

The hydrocele of the canal of Nuck is a rare medical condition that usually affects females during childhood and early adulthood. It is considered the female homolog to the testicular hydrocele in males, as they share similar pathophysiology. The condition is often underreported and considered an incidental finding. On many occasions, it is mistakenly diagnosed and even managed as an inguinal hernia. The hydrocele of the canal of Nuck is usually managed surgically, either by open surgery or laparoscopy. In this case report, we will discuss the hydrocele of the canal of Nuck diagnosed in a young adult female and provide a background, case presentation, and thorough discussion.

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.

Laparoscopic surgical treatment for hydrocele of canal of Nuck: A case report and literature review

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.

Laparoscopic hydrocelectomy of the canal of Nuck in adult female: Case report and literature review

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A very rare case of hydrocele of canal of Nuck in elderly lady.

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This case expands the clinical and intraoperative potential differential diagnosis of adult female groin masses.

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Hydrocele of canal of Nuck must be considered one of the differential diagnosis in ladies with inguinal masses.

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Laparoscopic TAPP is superior to open approach in managing such cases.

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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.

Clinics in diagnostic imaging (183)

Hydrocoele of the canal of Nuck is a rare condition in adult women caused by a failure of complete obliteration of the canal of Nuck. It may be likened to a patent processus vaginalis in men. In most cases, the diagnosis is made during surgery as it is often mistaken for an inguinal hernia. We report a case where the diagnosis of this condition was made preoperatively on imaging. The salient anatomy, clinical features, radiological images and surgical management are discussed and the medical literature reviewed.

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

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

Groin hernia diagnostics: dynamic inguinal ultrasound (DIUS)

PURPOSE

Although clinical examination is the gold standard for the diagnosis of groin hernia, imaging procedures can improve the detection of femoral hernias, incipient hernias, and less-common types of hernias (e.g., an obturator hernia). The aim of this study is to evaluate the sensitivity and specificity of dynamic inguinal ultrasound (DIUS).

MATERIALS AND METHODS

Between July 2010 and June 2015, 4951 clinical and ultrasound examinations of the groin area were conducted at the Hanse-Hernienzentrum in Hamburg, Germany. The ultrasonographic findings were prospectively evaluated to determine the number of inguinal and femoral hernia diagnoses that were ultrasonically confirmed and also to consider cases in which clinical examination overlooked these diagnoses. The results were compared with the intraoperative findings.

RESULTS

The results show that standardized ultrasound examination of the groin area with high-frequency, small-part linear transducers also serves to accurately display femoral and small or occult groin hernias. The high-level specificity (0.9980) and sensitivity (0.9758) are proof of the procedure's quality.

CONCLUSIONS

To ensure high-quality hernia treatment, regular use of standardized ultrasound examinations is recommended.

Hybrid laparoscopic and anterior approach for postsurgical inguinal hernia after iliofemoral arterial bypass

Laparoscopic hernia repair has become popular due to its rapid recovery time, fewer postoperative complications, and less chronic pain compared with conventional approaches. Currently, laparoscopic hernia repair is also used for more complex pathogenesis, including extra-anatomic bypass surgery for femoral artery. To the best of our knowledge, cases of inguinal hernia after femoral arterial bypass are extremely rare. We report the case of a 77-year-old Japanese man who was diagnosed with inguinal hernia after a previous left external iliac artery-right common femoral artery bypass. We used a hybrid laparoscopic and anterior approach, and the procedure was completed successfully without perioperative complications. A laparoscopic approach is useful for the diagnosis and treatment of inguinal hernia after extra-anatomic bypass surgery for femoral artery. While complicated, the addition of anterior reinforcement should be considered in cases of insufficient preperitoneal repair using transabdominal preperitoneal patch plasty.

Laparoscopic diagnosis and treatment of a hydrocele of the canal of Nuck extending in the retroperitoneal space: A case report

INTRODUCTION

Hydrocele of the canal of Nuck is a rarely encountered entity. We report a case underwent laparoscopic totally extraperitoneal (TEP) treatment for a hydrocele of the canal of Nuck extending in the extraperitoneal space mainly.

PRESENTATION OF CASE

A 37-year-old woman complained of painless and reducible swelling in her left groin, and referred to our hospital for surgical management against left inguinal hernia with the incarcerated ovary. Ultrasonography and MR images revealed a cystic mass in the retroperitoneal space, and we diagnosed as an unusual type of hydrocele of the canal of Nuck. The patient was scheduled for laparoscopic treatment. Laparoscopic findings on pneumoperitoneum showed an extraperitoneal cystic tumor with no contact with the left ovary. The fascia and peritoneum of the port site were closed, and then an extraperitoneal space was created. The cystic tumor with the round ligament of the uterus was dissected and resected by the TEP technique. The extended deep inguinal ring was repaired with polypropylene mesh. Postoperative course was uneventful.

DISCUSSION

Hydrocele of the canal of Nuck in the adult female is a rare condition. The accurate diagnosis of an inguinal hydrocele in a female is seldom made. Laparoscopic examination provides surgeons with information of inguinal swelling accompanied with retroperitoneal cyst, and consecutive treatment by laparoscopic technique, especially TEP, is useful in regard to minimal damage of the peritoneum.

CONCLUSION

Laparoscopic diagnosis and TEP treatment offers a useful alternative in selected patients with hydrocele of the canal of Nuck.