Original ArticleIs the ovary in an inguinal hernia ‘descended’ like a testis or not?
Section snippets
Methods
The English literature from the 1950s to the present was searched for articles about ‘female inguinal hernia’, inguinal hernia and ovary, inguinal hernia in women, round ligament, female gubernaculum, canal of Nuck, and female incarcerated inguinal hernia. The databases searched included PubMed, Medline and Web of Science.
The initial search revealed 4594 articles, and scanning the titles and abstracts identified 39 original articles and 1 review containing information on inguinal hernia in
Results
Forty papers published between 1957 and 2014 provided the raw data for this report, and describe the characteristics of > 7140 inguinal hernias in girls or women. Nine case reports describe the ovary in the hernia sac [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16] as well as 3 systematic reviews [17], [18], [19], [20]. Several reviews of inguinal hernia in females report that 15–20% of hernias were sliding and contained ovary and/or fallopian tube [19], [20], [21],
Discussion
This review demonstrates that in females, the inguinal hernial sac frequently contains the ovary as part of a sliding hernia (15–20%) [19], [20], [21], [22], [23], [34], [35], [36], [37], [38]. Gonadal ‘descent’ with the gubernaculum attached proximally to the gonad and distally to the tissue at or distal to the external inguinal ring, is extremely rare, and is only documented clearly in the literature where there is an associated anomaly of the Müllerian duct fusion and/or caudal migration,
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Cited by (16)
Hernia uteri inguinale in an 18 months old female infant: A case report
2021, International Journal of Surgery Case ReportsCitation Excerpt :The hernia sac in female infant commonly contains ovary hence the name ovarian hernia, differential diagnosis includes hydrocele of canal of Nuck [1]. In forty reports of >7140 inguinal herniotomies and/or imaging studies in females, the hernia contains an ovary in 15–20%, often with the ipsilateral fallopian tube [9]. However, an inguinal hernia containing the uterus is extremely rare which is known as Hernia uteri inguinale.
A Case of Mayer-Rokitansky-Küster-Hauser Syndrome Diagnosed in Infancy after Evaluation of Palpable Gonads
2020, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :MRKH syndrome has no known genetic etiology, so the unremarkable DSD genetic panel is consistent with this diagnosis. Inguinal hernias in otherwise healthy female children contain ovaries and/or Müllerian structures approximately 15%-20% of the time.2 In a review of 195 female individuals with inguinal ovaries, from infancy to more than 50 years of age,3 10% had bilateral inguinal ovaries and 8% had abnormalities of the genital tract.
Diagnosis and treatment of the intra-abdominal gonad in the pediatric population: Testes, ovaries, dysgenetic gonads, streaks, and ovotestes
2020, Journal of Pediatric SurgeryCitation Excerpt :The cranial suspensory ligament forms the future infundibulopelvic ligament and interestingly patients with herniated ovaries tend to have sliding hernias also containing the cranial suspensory ligament. This suggests that ovarian hernias are due to pulling of the ovary and its suspensory ligaments into the inguinal canal and not over descent from too much traction by the gubernaculum [88]. Ovarian torsion is found in around 3% of children presenting with acute abdominal pain [89], it is more common in post-pubertal girls but can happen at any age and should be suspected in pediatric female patients presenting with abdominal pain especially when associated with emesis [90].
Incarcerated uterus and bilateral ovaries in a premature female infant inguinal hernia
2020, Journal of Pediatric Surgery Case ReportsCitation Excerpt :However, the predominance of left sided inguinal hernias containing uterus and bilateral adnexa and indirect inguinal hernias in premature infants may suggest an incompletely synchronous bilateral obliteration of the Canal of Nuck. The existing literature suggests that the uterus, fallopian tubes, and bilateral ovaries end up in the hernia sac due to a sliding hernia mechanism, whereby the peritoneum brings the ipsilateral ovary and fallopian tube via traction on the attached cranial suspensory ligament, then takes the uterus and contralateral ovary by virtue of the broad ligament [6,18]. This appeared to be the case for this patient.
The possible role of AMH in shortening the gubernacular cord in testicular descent: A reappraisal of the evidence
2017, Journal of Pediatric SurgeryCitation Excerpt :By contrast, the human T-shaped genital tract is very different in shape from the V-shaped rodent uterus, which is associated with the ovary behind and very close to the internal inguinal ring, rather than adjacent to the kidney [29]. The female gubernaculum in the human takes a zigzag pathway to the inguinal canal, first passing medially as the ligament of the ovary to the uterus, and then laterally again as the round ligament to the internal ring [29], although whether the ligament of the ovary is part of the gubernaculum is disputed by some authors [30]. The CSL is vestigial in the human, while in the rodent it is a definite structure.
Large Canal of Nuck Hernia: The Female Equivalent of the Inguinoscrotal Hernia
2023, American Surgeon