Canal of nuck hernia with uterus and ovary presenting as inguinal swelling in a female infant.

Canal of nuck hernia is rarely reported in pediatric population. We report one such case of a canal of nuck hernia in a 2-month-old girl containing uterus, ovary and small bowel diagnosed on ultrasonography, and which was later confirmed and treated surgically.

The Cyst of the Canal of Nuck: Anatomy, Diagnostic and Treatment of a Very Rare Diagnosis-A Case Report of an Adult Woman and Narrative Review of the Literature.

The cyst of the canal of Nuck is an extremely rare female hydrocele, usually occurring in children, but also in adult women. It is caused by pathology of the canal of Nuck, which is the female equivalent to the male processus vaginalis. Due to its rarity and the lack of awareness among physicians, the cyst of the canal of Nuck is a seldom-encountered entity in clinical practice and is commonly misdiagnosed. We report on a case of cyst of the canal of Nuck in a 42-year-old woman, who presented with a painful swelling at her right groin. In addition, we conducted a review of the current available literature. This review gives an overview of the anatomy, pathology, diagnostics, and treatment of the cyst of the canal of Nuck. The aim of this review is not only to give a survey, but also to raise awareness of the cyst of the canal of Nuck and serve as a reference for medical professionals.

How embryology knowledge can help radiologists in the differential diagnosis of canal of Nuck pathologies.

The Canal of Nuck (CN) is an anatomical structure which is often forgotten. It is the female equivalent of the male processus vaginalis and corresponds to a protrusion of parietal peritoneum that extends from the inguinal canal to labia majora. Radiologists rarely encounter patients with pathology of CN, especially in adult population. It is well known that CN diseases can occur in paediatric patient (especially younger than 5 years of age) and they are associated to high morbidity (for example ovarian hernia with high risk of incarceration and torsion). The aim of our work is to review embryology, anatomy and pathologies of the CN thanks to a multi modal approach-ultrasound (US), Computed Tomography (CT) and Magnetic Resonance imaging (MRI)-to make radiologists more aware of such conditions and guarantee a prompt and correct diagnosis not only in paediatric patients but also in the adult population.

Canal of Nuck Abnormalities.

Canal of Nuck abnormalities are underrecognized causes of labial masses with potential adverse outcomes. The 2 main categories of canal of Nuck abnormalities are hernias and hydroceles. There are 3 types of canal of Nuck hydroceles: communicating, encysted, and bilocular. Canal of Nuck hernia contents vary, but those containing ovaries need urgent medical attention because of an increased risk of ischemia. Ultrasound can establish a definite diagnosis in all cases. This article reviews the embryologic characteristics, anatomy, pathologic characteristics, and imaging features of these abnormalities while providing a clear pictorial depiction of various unique hernias and hydroceles seen with this entity.

Canal of Nuck hernia: a multimodality imaging review.

Canal of Nuck abnormalities are a rare but important cause of morbidity in girls, most often those younger than 5 years of age. The canal of Nuck, which is the female equivalent of the male processus vaginalis, is a protrusion of parietal peritoneum that extends through the inguinal canal and terminates in the labia majora. The canal typically obliterates early in life, but in some cases the canal can partially or completely fail to close, potentially resulting in a hydrocele or hernia of pelvic contents. Recognition of this entity is especially important in cases of ovarian hernia due to the risk of incarceration and torsion. We aim to increase awareness of this condition by reviewing the embryology, anatomy and diagnosis of canal of Nuck disorders with imaging findings on US, CT and MRI using several cases from a single institution.

Cysts of the canal of Nuck: A rare sonographic diagnosis.

The canal of Nuck is a remnant of a peritoneal evagination associated with the round ligament in women. Rarely, the canal of Nuck can remain patent allowing for development of cysts. These cysts are difficult to diagnose due to their rare incidence and because they are often mistaken for other causes of inguinal pain in women. This case series of three women presenting with groin or labial masses highlights the role of sonography as the primary imaging modality in the diagnosis of canal of Nuck cysts. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:175-178, 2017.

Cyst of the canal of nuck in a two year old girl.

The canal of Nuck is analogous to a patent processus vaginalis in a male, which normally loses its communication to the peritoneal cavity within the first year of life. Failure of obliteration of this tract can result in a hydrocele. We present a rare case of a 2-year-old girl with left-sided groin swelling, diagnosed as inguinal hernia. Patient underwent surgical exploration and establishes definitive diagnosis as cyst of the canal of Nuck.

Uncommon content in congenial inguinal hernia.

Although sliding indirect inguinal hernias containing the ipsilateral ovary and fallopian tube are not uncommon in infant girls, sliding hernias containing uterus with both ovaries and fallopian tubes are extremely rare. At surgery, a 5-month-old infant girl was found to have an indirect hernia in which the uterus and fallopian tubes were sliding components with a wide deep inguinal ring.

Laparoscopic excision of cyst of canal of Nuck.

Hydrocele of the canal of Nuck is a rare condition in females. It results from the failure of obliteration of the distal portion of evaginated parietal peritoneum within the inguinal canal which forms a sac containing fluid. Patients generally present with inguinal swelling. We present a case of left sided cyst of canal of Nuck with left inguinal hernia in a 28-year-old female, which was diagnosed on ultrasonography. Patient underwent laparoscopic excision of cyst of canal of nuck with hernioplasty. Histopathology confirmed the diagnosis. To our knowledge, this is the first reported case of laparoscopic excision of a cyst (encysted hydrocele) of the canal of Nuck.

Nuck Canal Endometriosis Following IVF Attempts in a Young Patient-Report of a Case.

INTRODUCTION: Endometriosis is a common benign condition affecting 10-15% of women of reproductive age. An unusual site of endometriosis is the canal of Nuck, which is a physiologically obliterated space in women spanning the area from the deep inguinal ring to the labia majora. CASE PRESENTATION: A 37-year-old woman, with a past medical history of several in vitro fertilization attempts, presented with a right-sided painful inguinal mass. She was subsequently offered surgical exploration and excision of the lesion, which revealed the presence of endometrial glands and stroma. DISCUSSION: Despite being a relatively common and benign pelvic condition, endometriosis can rarely manifest in the inguinal region, within the canal of Nuck. The treating physician should be cognizant of Nuck canal endometriosis, especially in young female patients presenting with an irreducible mass in the inguinal region and associated cyclic pain or infertility. CONCLUSION: When clinically and radiologically suspected, surgical excision is indicated to establish the diagnosis, provide symptomatic relief and guide further decision making.

Cyst of the Canal of Nuck: a case report.

The cyst of the Canal of Nuck, or hydrocele, is a rare pathological condition in the female inguinal region. We present a 44-year-old female with a cystic lesion in the right inguinal area, detailing clinical symptoms, differential diagnosis and imaging findings. Surgical intervention involved complete cyst excision, with no recurrence during the follow-up. This case underscores the importance of accurate diagnosis and targeted surgical treatment for favourable outcomes in managing rare anatomical variations like the Canal of Nuck cyst.

A Canal of Nuck Cyst Presented as a Femoral Hernia: A Rare Case Report With Diagnostic Dilemma.

A cyst of the canal of Nuck is an uncommon disorder in females. It results from the failure of obliteration of the peritoneal fold that runs along the round ligament. This case report details a unique and rare presentation of a 38-year-old female who presented with a right groin swelling. Although her preoperative images showed only the right canal of the Nuck cyst, the intraoperative diagnosis was established as a femoral hernia containing a canal of the Nuck cyst. She underwent an elective cyst excision with repair of the femoral hernia. She had an uneventful post-operative recovery. A femoral hernia that contains a cyst of the canal of Nuck is a rare manifestation of this uncommon condition. The most effective treatment options are surgical cyst excision and repair of the femoral hernia.

Hydrocele of the canal of Nuck: a rare differential diagnosis for an inguinal hernia.

Hydrocele of the canal of Nuck is a rare condition which is commonly misdiagnosed as an inguinal hernia due to the unfamiliarity of clinicians with this pathology. There are three different types of hydrocele of the canal of Nuck, with type 1 being the most common, typically presenting as a unilocular cystic lesion with no communication with the peritoneal cavity. We present a case of a two-month-old female patient with an enlarging inguinal swelling raising the suspicion for an inguinal hernia or lymphadenopathy, with sonographic imaging revealing a fluid collection in the canal of Nuck, suggestive of a hydrocele. Diagnostic radiology plays a crucial role in the initial diagnosis of a canal of Nuck hydrocele, and ultrasound is considered the modality of choice for early diagnosis differentiating it from other causes of inguinal swelling.

Hidden Depths: Unveiling Endometriosis in the Canal of Nuck.

Endometriosis located within the canal of Nuck represents a highly uncommon occurrence, often posing a diagnostic challenge due to its atypical site and varied clinical presentations. The case of a 31-year-old female who presented with groin swelling and subsequent suprapubic pain for a duration of two years is described in this study. Utilizing magnetic resonance imaging (MRI), a cystic lesion was detected within the canal of Nuck, raising suspicion of endometriosis. Surgical exploration confirmed the presence of endometrial implants, supporting the initial radiological findings. This particular case emphasizes the significance of imaging techniques in diagnosing endometriosis in unusual sites, thereby enabling timely interventions and enhancing patient outcomes. Furthermore, it underscores the necessity of a multidisciplinary approach involving radiologists, gynecologists, and surgeons in ensuring comprehensive care for such patients. In the subsequent sections, we endeavor to present a unique instance of endometriosis within the canal of Nuck, a condition scarcely documented in the existing global literature. Our objective is to heighten awareness and encourage the consideration of endometriosis as a potential differential diagnosis in females presenting with inguinal masses and pelvic discomfort.

Totally laparoscopic surgery for a hydrocele of the canal of Nuck extending from the abdominal cavity to the subcutaneous space: a case report.

BACKGROUND: Hydrocele of the canal of Nuck (HCN) is a rare disease, and its indications for laparoscopic surgery are not well-established. CASE PRESENTATION: A 53-year-old woman was referred to our hospital due to an uncomfortable thumb-sized inguinal mass. Preoperative computed tomography scan and magnetic resonance imaging revealed a hydrocele extending from the abdominal cavity around the left deep inguinal ring via the inguinal canal to the subcutaneous space. The patient was diagnosed with HCN protruding into the abdominal cavity and extending to the subcutaneous space. Laparoscopy can easily access the hydrocele protruding into the abdominal cavity. Furthermore, laparoscopic hernioplasty can be superior to the anterior approach for females. Hence, laparoscopic surgery was performed. After transecting the round ligament of the uterus, a tense 3-cm hydrocele was dissected with it. In order to approach the hydrocele distal to the deep inguinal ring, the transversalis fascia was incised medially to the inferior epigastric vessels. The subcutaneously connected hydrocele was excised from the incision. Then, the enlarged deep inguinal ring was reinforced using a mesh with the laparoscopic transabdominal preperitoneal approach. The patient was discharged 2 days postoperatively. Laparoscopic resection can be more effective for a hydrocele protruding into the abdominal cavity as it facilitates an easy access to the hydrocele. Moreover, laparoscopic resection of a hydrocele extending from the inguinal canal to the subcutaneous space via a transversalis fascia incision can be safer, with low risk of injury to the inferior epigastric vessels. The incised transversalis fascia and the enlarged deep inguinal ring due to the HCN were simultaneously repaired with the laparoscopic transabdominal preperitoneal repair. There are two reports on laparoscopic resection via a transversalis fascia incision for HCNs located between the inguinal canal and the subcutaneous space, which does not require intraperitoneal hydrocelectomy. However, this is the first report on laparoscopic resection of large HCNs protruding into the abdominal cavity and extending beyond the inguinal canal into the subcutaneous space via intraperitoneal hydrocelectomy and a transversalis fascia incision. CONCLUSIONS: Laparoscopic surgery with transversalis fascia incision can be useful for HCNs extending from the abdominal cavity to the subcutaneous space.

A case of giant labia majora lipoma in an adult.

Lipomas are common benign adipose tissue tumors but are infrequently found in the labia majora, especially at a large size. We report a case of a giant lipoma of the labia majora in a 37-year-old woman diagnosed by imaging methods and successfully treated by surgery. This case highlights the importance of considering lipoma in the differential diagnosis of labial masses and underscores the role of imaging in diagnosis. They need to be differentiated from liposarcoma or omental herniation into Nuck's canal. It also demonstrates the effectiveness of surgical management for large lipomas in sensitive areas, with attention to both medical and aesthetic outcomes.

Laparoscopic Versus Open Surgical Management of Hydrocele of the Canal of Nuck: A Retrospective Analysis of 20 Cases.

INTRODUCTION:  Hydrocele of the canal of Nuck is a condition that arises due to incomplete obliteration of the processus vaginalis or an abnormal outpouching from the round ligament during fetal development. It usually presents as a painless, rarely painful, groin swelling. The definitive diagnosis for this condition is magnetic resonance imaging. Various management options have been proposed for this condition, including open surgery, transabdominal preperitoneal approach, totally extraperitoneal approach, and a combination of laparoscopic and open surgery. The present study highlights the benefits of the transabdominal preperitoneal approach when compared with the open anterior approach and addresses the intraoperative challenges faced during laparoscopic surgery. MATERIALS AND METHODS:  The study is a retrospective study inclusive of 20 patients who underwent surgery for the hydrocele of the canal of Nuck from June 2019 to December 2023. Case records of patients were studied for information such as demographic features, type of pathology, the surgery performed, intraoperative challenges encountered, operative time, duration of hospital stay, scores from the visual analog scale pain assessment chart at various intervals, and time taken to return to work. The variables were documented and statistically analyzed. RESULTS:  The average age group of the study population was 27.8 ± 8.34 years. Of the 20 patients, 10 had undergone a transabdominal preperitoneal approach (Group A), and 10 had undergone an open anterior approach (Group B). Eleven out of 20 patients had an associated inguinal hernia, of which three were identified preoperatively and eight were identified incidentally during surgery. The mean operative time of Group A cases was 97.95 ± 7.54 minutes, while it was 66.3 ± 6.20 minutes for Group B cases. The Mann-Whitney U test showed a statistically significantly lesser operative time for Group B than for Group A (p-value < 0.001). The duration of hospital stays was comparable for the two groups with no significant difference (two days versus 3.8 ± 3.08 days, respectively). When the difference in the means of time taken to return to normal work was compared using the Mann-Whitney U test between Group A and B (6.1 ± 0.87 days and 11.2 ± 1.81 days, respectively), a statistically significant early return to normal work in the former group (p-value = 0.001) was revealed. Similarly, the Mann-Whitney U test when used to compare the median postoperative pain score of both groups at 12-24 hours, 48-72 hours, seven days, and three months showed a significantly lesser pain score among patients of Group A at all intervals (p-value < 0.001, p-value = 0.005, p-value = 0.005, p-value < 0.001, respectively). The incidence of intraoperative challenges, sero-hematoma, and surgical site infection were insignificant in comparison. CONCLUSION: The transabdominal preperitoneal approach for the hydrocele of the canal of Nuck is ideal as it offers excellent intraoperative delineation of pathology and postoperative outcomes. Prophylactic placement of a mesh in all cases can help prevent a future occurrence of inguinal hernia in these cases.

Bilateral hydrocele of the canal of Nuck: A case report.

INTRODUCTION: The hydrocele of the canal of Nuck is a rare cause of bilateral inguino-labial swelling. Due to its rarity, lack of clinician knowledge regarding this entity, and paucity of relevant literature, it can be misdiagnosed and often mistreated. CASE PRESENTATION: We present a case of a two-year-old female with bilateral inguino-labial swelling who was diagnosed with a hydrocele of the canal of Nuck based on history and clinical examination. The patient underwent bilateral hydrocele excision with high pouch ligation, and she experienced an uneventful recovery. DISCUSSION: Bilateral hydrocele of the canal of Nuck is rare in females. Diagnosis can be made based on history and clinical findings. In cases of diagnostic uncertainty, preoperative ultrasonography may aid in diagnosis. Management of hydrocele of the canal of Nuck involves surgical intervention, which is necessary for both definitive diagnosis and treatment. CONCLUSIONS: Although rare, hydrocele of the canal of Nuck must be suspected in cases with inguino-labial swelling, properly diagnosed, and surgically excised. It can be misdiagnosed; therefore, clinicians need to have a high index of suspicion to reach a provisional diagnosis and prevent morbidity and further complications.

The Rarest Variant Type Of Groin Cystic Mass In Adult Female: Encysted Hydrocele Canal Of Nuck.

INTRODUCTION AND IMPORTANCE: Hydrocele canal of the nuck is one of the rarest clinical conditions encountered in adult females. It occurs as a result of a failure to obliterate the canal. CASE PRESENTATION: This case report details the surgical treatment in 25 - years old young female presented to the surgical clinic with a one-month history of right-sided painful palpable inguinolabial swelling. A large well-circumscribed cystic lesion with multiseptated, thin walls with no evident peritoneal cavity connectivity was seen on abdominal sonography and enhanced computerized tomography (CT) scan. The patient underwent surgical exploration, and the intraoperative findings revealed an encysted hydrocele distally at the external inguinal ring, with the canal of nuck partially obliterated in the midpoint and the proximal end communicating with a peritoneal cavity at the deep inguinal ring. The hydrocele and round ligament were excised, the canal of the nuck was high-ligatured, and the self-fixing prosthetic mesh was then utilized to repair the anatomical defect through the right inguinal skin creases approach. The patient had a smooth post-operative recovery and was discharged the next day with outpatient surveillance. The patient rested asymptomatic and experienced no recurrence three months after surgery. CLINICAL DISCUSSION: Female hydrocele, often called "hydrocele canal of nuck," is a rare developmental abnormality that typically presents later in life, and the condition is poorly understood among surgeons due to the lack of information on this clinical entity in surgical and gynecological textbooks, as well as the rarity of the disorder itself, both of these factors contribute to misdiagnosing as an irreducible inguinal hernia or a femoral hernia is possible in practice. CONCLUSION: Hydrocele ultrasound-guided aspiration has no place in surgical practice. The surgical exploration approach is the only practical and standard therapy.