Irreducible Indirect Inguinal Hernia in Premature Infant with Ectopic Uterus and Bilateral Adnexa

Hassan Ibrahim, MD; Mohga Khaled, MD; Thomas Gates, MD; Hilary Trice, Pharm. D; Guillermo Sangster, MD




Indirect inguinal hernia is one of the most common congenital anomalies in children, with a reported prevalence of 0.8-4.4%.1 About 15-20% of hernias in female infants contain ovary, and in rare cases a fallopian tube.2 However, only a few cases contain the uterus and both ovaries in the hernia sac.3 The normal anatomy is altered when an ovary is trapped in a hernia sac, and these changes make torsion more likely and increase the risk of infertility. 

Although an irreducible ovary is not at great risk of compression of its blood supply, in these occurrences, ovarian torsions have been reported in 2%–33%, emphasizing the importance of early surgical repair in irreducible hernias, even in asymptomatic patients.4 The presentation of an asymptomatic palpable movable mass over the labium major always suggests sliding hernia with ovary. To our knowledge, only a few reports of hernia sac containing uterus, fallopian tube, and ovary in a female patient have appeared in the literature. We suggest that sonography be performed routinely in female infants with an inguinal hernia containing a palpable movable mass. We present a rare case of premature female infant with a labial mass containing the uterus, both ovaries, and fallopian tubes.




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