Original Article
Is the ovary in an inguinal hernia ‘descended’ like a testis or not?

https://doi.org/10.1016/j.jpedsurg.2015.09.014Get rights and content

Abstract

Background/aim

How testes descend through the inguinal canal is well described, but how the ovaries appear inside an inguinal hernia remains controversial. We reviewed the literature to determine whether ovarian ‘descent’ has been described.

Methods

The English literature from 1950 to 2014 was reviewed via PubMed, Medline and Web of Science to identify papers describing an ovary in the hernia sac: reports were examined to find whether the ovary prolapsed or ‘descended’, and the anatomy of its supporting ligaments, cranial suspensory ligament (CSL) and round ligament (female gubernaculum, RL).

Results

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. The RL and ovary were aligned along the same path as testicular descent only rarely in Müllerian anomalies with an isolated uterine horn preceding the ovary into the sac. The ligament usually found inside the hernia sac was the CSL, not the RL.

Discussion

The high frequency of incarcerated ovary, along with the close proximity of the CSL to the internal ring in females is consistent with a sliding hernia pulling the CSL (and ovary) into the hernia sac, not ovarian ‘descent’ by traction on the RL.

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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