Cyst of the Canal of Nuck in adult females: A case report and systematic review

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.

Laparoscopic assisted hydrocelectomy of the canal of Nuck: a case report

“…Imaging, especially ultrasound (US), is helpful for timely diagnosis; Doppler ultrasound can confirm intestinal obstruction and ischemic necrosis [ 5 ]. It has been reported that CT scan or magnetic resonance imaging can more effectively observe the anatomy around the cyst and determine whether the cyst communicated with the abdominal cavity [ 1 ]. Even so, in some cases, the final diagnosis depends on the intraoperative findings [ 4 , 5 ].…”

“…Hydrocele of canal of Nuck (HCN) is a rare disease in adult women that is difficult to diagnose by preoperative imaging alone, and some patients may have a complicated inguinal hernia [ 1 – 3 ]. The traditional treatment method is to completely remove the hydrocele through an open anterior approach surgery [ 4 , 5 ].…”

Endometriosis of the Canal of Nuck: A Systematic Review of the Literature

“…Diagnosis of endometriosis in the NC is even more uncommon in patients with patent NC due to failure of the canal to close within the first year of life in females [ 47 ]. The aforementioned defect can result in hydrocele formation or herniation of intraabdominal surrounding tissues through the canal [ 47 ]. Under certain circumstances, which, however, remain unknown, the NC can be infiltrated by endometrial cells and results in the formation of endometriosis.…”

“…In some cases, a CT, MRI, or even a PET-CT supplemented the U/S findings. High-resolution U/S is an inexpensive and reliable modality to set the suspicion of diagnosis of the Nuck endometriosis [ 47 ]. Nonetheless, the final diagnosis is based on the histology and immunochistochemistry.…”

“…As shown in our study, surgical resection with simultaneous repair of the defect of the canal in the majority of cases is the optimal treatment option for patients with endometriosis of the NC. Similarly to the case of Nuck hydrocele, the gold standard treatment remains excision of the cystic structure (laparoscopic or open) and closure of the internal inguinal defect with or without mesh [ 47 ]. Additionally, in case of extension of the disease to the labia majora, a concomitant repair of the vulva may be necessary including vulvectomy or clitorectomy procedures depending on the extent of the disease [ 51 ].…”