Canal of Nuck Hernia in a Female Infant Containing Uterus, Bilateral Adnexa and Bowel

Abstract

Background:The canal of Nuck is a fold of peritoneum that invaginates into the inguinal canal and closes at or just before birth. If the canal of Nuck remains open in female infants, herniation of the uterus, adnexa and/or bowel loops may arise through the inguinal canal into the labia majora. Case Report: The present case is a 12-week-old female infant with complaints of left groin swelling and discomfort. Ultrasonographic examination revealed a left inguinal hernia containing both adnexa (ovaries and fallopian tubes), uterus and small bowel loops with fluid. Conclusion: A hernia containing ovary and uterus should be considered as a possible cause in a female infant with a groin mass. Ultrasonography of the inguinal mass lesions should be performed routinely in a female infant for accurate diagnosis.

Indirect inguinal hernia containing uterus, fallopian tube, and ovary in a term infant

“…Color Doppler may help to differentiate strangulation of herniated organs. Inguinal hernias, localized fluid collections or enlarged lymph nodes should be considered in the differential diagnosis [10]. Further examinations such as magnetic resonance imaging may be performed when US is not able to differentiate the content of hernia sac or strangulation.…”

Canal of Nuck Abnormalities

“…The processus vaginalis and gubernaculum are 2 main fetal structures that contribute to the prenatal development of the inguinal canal (Figure ) . The superior aspect of the gubernaculum attaches to the lower pole of the fetal gonad, and the inferior aspect of the gubernaculum attaches to the skin of the fetal groin .…”

“…It enters the inguinal canal through the deep inguinal ring, where it is positioned anterior to the gubernaculum but then lies medial to the gubernaculum within the inguinal canal (Figure ) . The obliteration of the processus vaginalis proceeds gradually in a superior‐to‐inferior direction . A patent canal of Nuck allows fluid or pelvic contents to herniate through the inguinal canal to the labia majora (Figure ).…”

“…Pediatric inguinal hernias commonly present during infancy and early childhood, with a reported incidence ranging between 0.8% and 4.4% . These hernias tend to be indirect inguinal hernias, which arise when abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels .…”

“…Pediatric inguinal hernias commonly present during infancy and early childhood, with a reported incidence ranging between 0.8% and 4.4% . These hernias tend to be indirect inguinal hernias, which arise when abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels . These indirect hernias occur through a patent inguinal canal due to failed closure of the embryonic processus vaginalis, a protrusion of the parietal peritoneum herniating into the fetal inguinal canal .…”