Female inguinal hernia - case presentation
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A rare case of inguinal hernia in female
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Female inguinal hernia - case presentation
- 1. A RARE CASE OF INGUINAL HERNIA IN FEMALE DR. PRIYADARSHAN KONAR, FINAL YEAR PGT PROF (DR.) P K SAHOO, DR. B. C. SAHOO, DR. SUMAN SAURAV ROUT PG Dept. of Surgery IMS & SUM Hospital Bhubaneswar
- 2. BACKGROUND • In adult surgery 80% of all hernia repairs are for inguinal hernia. • Though inguinal hernia in females are not as common as in males. It is interesting that 1 male in 5 and 1 female in 50 will eventually develop inguinal hernia in lifetime. • The ratio of male: female hernia is 10:1. • Inguinal hernia in females can either be congenital or acquired. • The incidence of indirect hernia relates to congenital weakness at the internal inguinal ring.
- 3. BACKGROUND(contd.) • There is no definite etiology behind acquired female hernias, but obesity, pregnancy and operative procedures contribute to the formation of female inguinal hernia. • We have come across a rare case of inguinal hernia in a female patient where the uterus and right ovary and fallopian tube were in the hernia sac.
- 4. CASE REPORT • A 53-year old female. • Presented with soft swelling in her right groin for last 2years. • On physical examination approx.size 5cmx6cm, pyriform in shape. • Extension to the right Labia majora. • Swelling was reducible and non tender. • Skin over the swelling was normal. • Cough impulse was positive.
- 5. CASE REPORT(contd.) • Other abdominal findings were normal. • Menstrual history revealed amenorrhea since puberty. • Well developed secondary sexual characters. • She was diagnosed with right sided inguinal hernia.
- 6. INVESTIGATIONS • Ultrasonography of abdomen and pelvis reported non-visualization of uterus, ovaries and left kidney. • Hematological and biochemical reports were within normal limit.
- 8. MANAGEMENT • On table diagnostic laparoscopy was done, which revealed empty pelvic cavity with absence of uterus and ovary.
- 9. • After diagnostic laparoscopic confirmation hernia repair was planned. • Hernia was approached through a parainguinal incision on right side. • The hernia sac was identified and opened. • The contents of the hernia sac were rudimentary uterus and right- sided ovary.
- 10. MANAGEMENT • Hysterectomy and salpingo- oophorectomy was done. • Herniorrhaphy was done.
- 11. • Post operative chromosomal study shows normal female karyotype, 46XX.
- 12. DISCUSSION • All inguinal hernias in females occur as indirect protrusions. • Sliding hernias of the uterus, ovaries and fallopian tube occur occasionally in newborn female infants, but are rare in older women. • When found in a woman of reproductive age, these are commonly associated with defects in genital tract development; as in this patient absence of external os is noted.
- 13. DISCUSSION(contd.) • Hernia uterus inguinale is a rare congenital anomaly found in hermaphrodites. • In this patient genetic study was done and found to be normal female karyotype (46,XX). • Mullerian duct agenesis.
- 14. REFERENCES 1. Female inguinal hernias and testicular femization; Carmichael DH, et al. South Med J. 1981 2. Inguinal hernia in female; Lt Col S. Chawla 3. Risk factors for Inguinal Hernia in female: A case-control study; Mike S.L.Liem Yolanda van der Graaf, Reinder C. Zwart, 4. Ingrid Geurts, and Theo J.M. V. van Vroonhoven on behalf of the Coala Trial Group 5. Non-palpable inguinal hernia in the female; Spangen L, Andersson R, Ohisson L