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Case Report
V. Golash1 R. S. Cummins2
1Department of Surgery, Sultan Qaboos Hospital, Sultanate of Oman
2Queen Mary’s University Hospital, Roehampton Lane, London
Correspondence to: V. Golash, Sultan Qaboos Hospital, P O Box 98, Salalah, Pin Code 211, Sultanate of Oman Email: golash@omantel.net.om; haritagolash@hotmail.com
Keywords: Inguinal hernia Surgeon, 1 February 2005, 48
Background: An ovary can, occasionally, be found in an inguinal hernia in the newborn female. This is extremely rare in premenopausal women. We report a case of an ovulating ovary in an incarcerated inguinal hernia. There is only one similar case of incarcerated ovulating ovary reported in the literature. Method and Findings: A 23-year-old Turkish woman, mother of three children, presented with a painful swelling over the upper part of left labia majora of 48 hours duration. She was diagnosed as having an obstructed left inguinal hernia. At operation the left ovary and fallopian tube were seen in the left inguinal canal. The ovary and fallopian tube were congested but viable and mature ovarian follicles could be seen on the ovary. A biopsy was taken from the ovary, the ovary and the fallopian tube were easily reduced back into the abdominal cavity and the hernia repaired. Discussion: The presence of an ovary in the inguinal canal is very rare and should be a differential diagnosis in women presenting with an irreducible lump in the inguinal area. It should be treated as a surgical emergency
A 24-year-old Turkish woman presented to the emergency department with a painful swelling in the left inguinal region of 48 hours duration. She was not aware of any previous swelling in the same region. The swelling was gradually getting more painful and increasing in size. There were no other associated clinical features. She was in the middle of her menstrual cycle. On examination, she was of normal build, with normal secondary sexual characteristics. A tense, tender 4cm x 4cm spherical lump was felt over the upper left labia. The swelling was irreducible with no cough impulse. The rest of the abdominal and systemic examination was unremarkable. At operation, a healthy ovulating left ovary and fallopian tube was identified in the inguinal canal. A biopsy was taken, the hernial contents were easily reduced into the abdominal cavity and the hernial defect closed. Histopathological examination of the biopsy specimen confirmed the presence of follicles at varying stages of maturity.
During embryological development, the round ligament (remnant of the gubernaculum) traverses the inguinal canal into the labia majora. The labia majora in the female is analogous to the scrotum in the male. In the female, if the gubernaculum fails to adhere to the uterus the ovary may follow the round ligament and pass partly or entirely through the inguinal canal into the labium majora.1 This is commonly associated with defects in embryological development.2 An increased incidence is seen in prematurely born infants.2,3 In this patient there was no such history and no other associated anomaly. An irreducible ovary is at significant risk of torsion, where the internal ring serves as a fixed point around which a twist occurs leading to infarction. It is possible to recognize the ectopic inguinal ovary by high resolution ultrasonography, in females presenting with a palpable labium major mass.4 The incidence of a non-reducible ovary in female inguinal hernias is high and the recommendation is operative repositioning of the ovary, as early as possible, to avoid the risk of infarction.4-7
Copyright 26 October 2004
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