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Hernia uteri inguinale in an 18 months old female infant: A case report
Heba Taher1, Ahmed Azzam1, Ahmed Kamal1
1Pediatric Surgery Department, Cairo University, Egypt.
Insights
Uterus presence in pediatric inguinal hernia is rare but requires careful surgical dissection. Pediatric surgeons must be aware of this possibility for successful repair and to consider associated sexual development disorders.
Area of Science:
- Pediatric Surgery
- Reproductive Medicine
Background:
- Inguinal hernia is the most common childhood hernia.
- Ovaries and fallopian tubes are found in 15-20% of female inguinal hernias.
- Uterus presence in pediatric inguinal hernia is exceptionally rare.
Observation:
- An 18-month-old female presented with a right inguinal hernia.
- The surgical approach revealed the uterus, fallopian tubes, and ovary within the hernia sac.
Findings:
- Hernia uterii inguinale (uterus in inguinal hernia) is a rare condition.
- Potential causes include weakness in uterine/ovarian suspensory ligaments and Mullerian duct fusion failure.
- Associated disorders of sexual development may be present.
Implications:
- Surgical repair requires meticulous sac dissection due to strong organ attachment.
- Pediatric surgeons must be vigilant for uterus presence during inguinal hernia repair.
- Consideration of associated sexual differentiation disorders is crucial.
Introduction:
Inguinal hernia is the most frequent hernia of childhood. About 15-20% of females with inguinal hernias, the ovaries and/or the fallopian tubes may be contents of the herniation sac. Meanwhile uterus is very rare to be encountered. Our aim is to alert Pediatric surgeons to such condition and remind them of the important technical steps to treat and manage this condition.
Case Report:
Elective surgery on an 18 months old female child with right inguinal hernia was performed electively through an open inguinal approach; the uterus, fallopian tubes and ovary were found in the hernia sac.
Discussion:
The etiology of the hernia uterine inguinale in general is controversial, however there may be some degree of weakness of the uterine and ovarian suspensory ligament. Thompson noted that if there is failure of fusion of the Mullerian ducts, it leads to increase in the mobility of ovary and uterus, increasing the possibility of herniation of ovary, tubes and uterus. It was reported to be associated with disorders of sexual development. Surgical procedure for inguinal hernias containing uterus is often different from the ones containing only the ovary, as these organs are strongly attached to the hernia sac and it has to be freed from the wall of the hernia sac.
Conclusion:
We want to stress that in hernia uterii ovarii, dissection of the sac is essential for successful hernia repair unlike routine hernioraphy and to consider associated disorder of sexual differentiation.
