女性腹股溝卵巢疝氣 – 病例報告
許智凱、張廷瑞、陳世亮
台南市立醫院 泌尿科
Inguinal hernia with incarcerated ovary in woman:
Case report and literature review
Chih-Kai Hsu, Ting-Jui Chang, Shih-Liang Chen
Divisions of Urology, Tainan Municipal Hospital, Tainan, Taiwan
Background: Inguinal hernia is less common in women than in men, and ovarian hernias are extremely rare. Ovaries and fallopian tubes found in operable inguinal hernias is only about 2.9%, and mostly are prepuberty. We report an unusual case of ovary herniation in an adult female.
Case Report: A 41-year-old woman had suffered from a reducible 5x5 cm mass over left inguinal area for more than one year, and it became harder and irreducible in recent weeks. There’s no symptoms that indicated strangulated bowels in hernia, such as fever, nausea or vomiting. Under the clinical diagnosis of incarcerated hernia, open surgical repair was arranged. On surgical exploration, a round infarcted tissue was noted in the hernia sac with tube-like structure extended through the internal inguinal ring into abdominal cavity. Gynecologist was consulted and ultrasound showed absence of the left ovary in pelvic cavity. The infarcted tissue was resected and the defect was repaired. CT scan was arranged and confirmed the diagnosis post-operatively.
Discussion:. Inguinal hernias are more common in males, but they still can occur in females, most commonly the content is omentum or small bowel. A retrograde analysis of 1,950 cases of operable inguinal herniae showed that the vermiform appendix was present in 0.51% of the cases, ovaries and fallopian tubes in 2.9%, and urinary bladder in 0.36%. Ovarian hernias are extremely rare in premenopausal women. On the contrary, most cases of gonadal hernias were reported in the pediatric age group. T. Okada suggested a few hypotheses of the mechanism why this may occur. One of these hypotheses speculates that weakness of the broad ligaments or ovarian suspensory ligaments can contribute to ovarian herniation into the inguinal ring. This can be augmented by high intra-abdominal pressure as a result of carrying heavy things, or due to a chronic cough secondary to respiratory disease, as could happened in adult patient.