The presentation of asymptomatic palpable movable mass in female inguinal hernia

The surgical approach to the inguinal canal in girls is identical to that in boys. The sliding hernia which contains the ovary with or without the fallopian tube occurs occasionally in female patients. In our clinical experience, we found that a hydrocele in the labium, also presenting with an asymptomatic palpable movable mass, mimics a sliding hernia with ovary. In an attempt to differentiate between hydrocele and sliding inguinal hernia with ovary in female patients, we report our experience dealing with the two situations at a single institution within a 5-year period. Between July 1997 and June 2002, 1800 infants and children underwent surgery for inguinal hernia at Chang Gung Children's Hospital, of whom 580 were female infants and girls aged 1 month to 14 years (mean, 5.7 years). Some 32 patients (5.3%) presented with an asymptomatic palpable movable mass over the labium major. Pre-operative sonography was performed for all cases. Twenty-six female infants aged 1 month to 18 months (mean 5 months) had sliding hernia; both the ovary and fallopian tube were contained. Six girls aged 2 years to 6 years (mean 4.6 years), had hydrocele of the canal of Nuck. The accuracy of pre-operative diagnosis with sonography was 100%.

Sonography is an easy and accurate pre-operative diagnostic procedure. We suggest that sonography be performed routinely in all female cases with an inguinal hernia containing a palpable movable mass.