Journal List > J Korean Soc Radiol > v.75(3) > 1087704

Shin and Chai: Ultrasonographic and Clinical Findings of Inguinal Hernia Containing the Ovary or Omentum in Girls

Abstract

Purpose

To characterize the ultrasonographic and clinical findings of inguinal hernia containing the ovary or omentum in girls.

Materials and Methods

We studied 46 girls (49 cases) who were diagnosed with inguinal hernia on ultrasonography between March 2009 and December 2015. The ultrasonographic findings were retrospectively analyzed with respect to location, age at detection, contents of hernia, diameter of the canal of Nuck, and incidence of reducibility, incarceration and strangulation. The clinical findings included the number of cases that underwent operation, contents of hernia discovered during operation, and duration between ultrasonographic diagnosis and operation. The two groups in which inguinal hernia contained the ovary and omentum were statistically compared.

Results

Of the 49 cases, the contents of hernia were the ovary or tube in 14 cases, omentum in 32 cases, and bowel in 3 cases. The ovarian herniation group was significantly younger (10.1 months vs. 4.9 years, p < 0.001), had a lower incidence of reducibility (n = 3 vs. n = 29, p < 0.001), higher incidence of incarceration (n = 4 vs. n = 0, p = 0.006), and a shorter duration between ultrasonographic diagnosis and operation (5.7 days vs. 55.8 days, p = 0.032) than the omental herniation group.

Conclusion

The ovarian herniation group was younger, had a lower incidence of reducibility, higher incidence of incarceration, and a shorter duration between ultrasonographic diagnosis and operation.

Figures and Tables

Fig. 1

Ovarian herniation through the canal of Nuck in a 14-month-old girl.

A. Transverse ultrasonographic scan shows an ovary (arrow) located adjacent to the left proximal inguinal canal in the pelvic cavity on rest.
B. Transverse scan shows a fascial defect (arrows) of the dilated canal of Nuck connecting to the peritoneal space on rest.
C. Longitudinal scans show herniation of the left ovary (arrow) through the canal of Nuck on Valsalva maneuver (with crying) and spontaneous resolution of herniation on rest (data not shown).
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Fig. 2

Herniation of the left ovary and uterus through the canal of Nuck and deviation of the right ovary to the left pelvic cavity in a 1-month-old girl.

A. Transverse ultrasonographic scan shows the left ovary (arrow) herniated through the canal of Nuck.
B. Transverse scan shows the right ovary (open arrow) located adjacent to the left proximal inguinal canal on the left lateral aspect of the bladder.
C. Longitudinal scan shows herniation of the left ovary (arrow) and uterus (arrowheads) through the canal of Nuck. Deviation of the right ovary (open arrow) to the left pelvic cavity is also noted.
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Fig. 3

Tubal herniation through the canal of Nuck in a 5-month-old girl.

A. Transverse ultrasonographic scan shows an ovary (open arrow) located adjacent to the left proximal inguinal canal in the pelvic cavity.
B. Longitudinal scan shows a low echoic tubular dilatation of the canal of Nuck (arrow), suggesting a fallopian tube.
C. Longitudinal scan shows a fascial defect (arrowheads) of the dilated canal of Nuck connecting to the peritoneal space.
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Fig. 4

Herniation of the left omental fat through the canal of Nuck in an 8-month-old girl. Longitudinal scan shows herniation of omental fat (arrowheads) through the canal of Nuck on Valsalva maneuver and spontaneous resolution of herniation on rest (not shown).

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Fig. 5

Herniation of omental fat and fluid through the canal of Nuck in a 10-month-old girl.

A. Initial longitudinal ultrasonographic scan shows herniation of omental fat or tube (arrows) through the canal of Nuck and right ovary located adjacent to the right proximal inguinal canal (arrowheads) at postnatal age of 100 days.
B, C. Follow-up 7 months later, transverse (B) scan shows a normally located right ovary (arrowheads) at retrovesical pelvic cavity and longitudinal (C) scan shows the herniation of the omental fat and fluid (arrows) through canal of Nuck.
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Table 1

Ultrasonographic and Clinical Findings of Inguinal Hernia in Girls

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Group A (Ovary Herniation, n = 14) Group B (Omentum Herniation, n = 32) p-Value
Location of hernia (n) Right (7), left (7) Right (15), left (17) 0.845
Age of detection, average (range) 10.1 months (2 days–6 years) 4.9 years (39 days–10 years 8 months) < 0.001*
Contents of hernia on US (n) Ovary (12), tube (2) Omentum (32)
Diameter of canal of Nuck, average (range) 11.7 mm (7–16 mm) 12.3 mm (6–19 mm) 0.631
Reducibility on US (n) 3 29 < 0.001*
Incarceration (after manual reduction) (n) 4 0 0.006*
Strangulation on US (n) 1 0

*p < 0.05 indicates a significant difference among the groups.

US = ultrasonography

Table 2

Operative Findings of Inguinal Hernia in Girls

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Group A (Ovary Herniation, n = 11) Group B (Omentum Herniation, n = 23) p-Value
Operation (n)
 Elective op. 10 23
 Emergency op. 1 0
Contents of hernia on operation (n) 0.002*
 Empty sac 4 21
 Ovary 6 -
 Tube 1 -
 Omentum - 2
Duration between ultrasonographic diagnosis and operation, average (range) 5.7 days (1–14 days) 55.8 days (1 day–1 year 66 days) 0.032*

*p < 0.05 indicates a significant difference among the groups.

op. = operation

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