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OVARIAN INGUINAL HERNIA - A Case Report

DHARMESH J BALSARKAR*, MOHAN A JOSHI**
*Lecturer; **Professor and Head of Unit; Department of General Surgery, LTMMC and LTMG Hospital, Sion, Mumbai 400 022.

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Presence of ovary in inguinal hernias is known to occur occasionally in new born female, but is an extremely rare condition in young adult of reproductive age group. We report a case of ovarian inguinal hernia in an unmarried 19 year old female patient presenting as an incarcerated inguinal hernia. Medline search showed only two such reported case in females in reproductive age group.

INTRODUCTION

No disease of the human body, belonging to the province of the surgeon, requires in its treatment a better combination of accurate anatomical knowledge with surgical than hernia in all its varieties. [1] Stretching of abdominal musculature due to obesity and pregnancy can lead to hernias in elderly multipara.1 In females of reproductive age group developmental abnormality as a cause of this condition is advanced. [2,3]

CASE REPORT

A 19 year old female patient presented to us with irreducible swelling in the right groin since one month, no other positive history was noted. Menstrual cycles were normal. On examination, there was a 2 x 2 cm firm irreducible swelling noted in the right inguinal region, passing above and medial to the pubic tubercle. Rest of the abdomen was normal. A diagnosis of irreducible right inguinal hernia without obstructive symptoms was made. Patient was operated. At surgery a presence of right ovary and fallopian tube in inguinal hernia was noted (Fig. 1). Ovary was viable and was reduced back into the peritoneal cavity and a Bassini’s repair was performed for right inguinal hernia. The patient had an uneventful post operative surgery.

Fig 1: Intraoperative photograph showing the presence of ovary within the inguinal hernia.

DISCUSSION

The ligament that lies in the hernia sac of girls is the round ligament and is described as homologous to the male gubernaculum. An ovary in a hernia is not a prolapsed, but a descended gonad. [4]

Of the total incidence of female inguinal hernias, approximately 4% to 37% cases presented with nonreducible ovaries at the time of surgery, of which 2% to 33% the ovary was twisted and infarcted. [5,6]

Result of review of literature show that irreducible ovary is not a risk of compression of its blood supply, but at significant risk of torsion along with its tube on its pedicle whilst suspended from the neck of the hernial sac. [5-7] That is why asymptomatic nonreducible ovary should be treated as every incarcerated hernia - with urgent reduction, manual or operative. [6] Presented case underwent a surgical reduction with uneventful postoperative recovery.

REFERENCES

1.Kingsnorth A, Bennett DH. Hernias. Umbilicus. Abdominal wall. In : Russell RCJ, Williams NS, Bulstrode CJK, editors Bailey and Loves, Short practice of surgery. 23rd ed. London : Arnold publishers; 2000 chapter 62, 1143-62.

2.Bradshaw KD, Carr BR. Ovarian and tubal inguinal hernia. Obstet Gynecol 1986; 68 (3 suppl) : 50S-52S.

3.Amarin ZO, Hart DM. Inguinal ovary and fallopian tube - an unusual hernia. Int J Gynaecol Obstet 1988; 27 (1) : 141-3.

4.Ozbey H, Ratschek M, Schimpl G, Hollwarth ME. Ovary in hernia sac : prolapsed or a descended gonad? J Pediatr Surg 1999; 34 (6) : 977-80.

5.Boley SJ, Cahn D, Lauer T, Weinberg G, Kleinhaus S. The irreducible ovary : a true emergency. J Pediatr Surg 1991; 26 (9) : 1035-38.

6.Marinkovic S, Kantardzic M, Bukarica S, Grebeldinger S, Pajic M. When to operate nonreducible ovary? Med Pregl 1998; 51 (11-12) : 537-40.

7.Merriman TE, Auldist AW. Ovarian torsion in inguinal hernias. Pediatr Surg Int 2000; 16 (5-6) : 383-85.

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