A Alzaraa

DC Mandel

F Tagliaabue

NO Machado

W Al Omari

SpringerPlus

English

Mette L Josefsson

Surajit Mitra

Sanjay Gupta

Crossref

a SpringerOpen JournalJosefsson et al. SpringerPlus 2013, 2:545http://www.springerplus.com/content/2/1/545SHORT REPORT Open AccessInguinal ovary in adult women-case reportand literature reviewMette L Josefsson1*, Surajit Mitra1 and Sanjay Gupta2AbstractThis paper describes a rare finding of an inguinal ovary in an adult woman who presented with pelvic pain.Inguinal ovary may occur if the gubernaculum fails to attach to the uterus or if the canal of Nuck remains openduring fetal development.IntroductionOvary within the inguinal canal is occasionally seen ininfants, but is rare in adult women. This paper describesa woman with an inguinal ovary who presented with pel-vic pain. We review the literature and discuss its em-bryological background.Case reportA 33 year-old-woman presented with pelvic pain on abackground of longstanding left sided iliac fossa pain,which was exaggerated by constipation and movement.Past medical history included depression, scarred left kid-ney from recurrent urinary tract infections and surgeryfor urethral diverticulum. Obstetric history included twovaginal deliveries following subfertility treatment. Ultra-sound scan demonstrated an unremarkable retroverteduterus and normal renal tract. The right ovary appearednormal however left ovary was not identified. Diagnosticlaparoscopy revealed the left ovary herniating through theleft internal inguinal ring (Figure 1a-b). The left ovarianand round ligaments were absent and only a small left fal-lopian tube was seen (Additional file 1: Figure S1). Uterus,and right tube, ovary and round ligament appeared nor-mal. She later underwent laparoscopic mobilization of theovary and mesh repair of the inguinal canal jointly withthe general surgeons (Additional file 2: Figure S2). She re-covered well and was discharged home two days later.* Correspondence: m.josefsson@doctors.org.uk1Department of Obstetrics and Gynaecology, Lister Hospital, Coreys Mill Lane,Stevenage, Hertfordshire SG1 4AB, UKFull list of author information is available at the end of the article© 2013 Josefsson et al.; licensee Springer. ThisAttribution License (http://creativecommons.orin any medium, provided the original work is pCommentA literature search revealed twelve case reports in adults.The majority presented with a palpable groin mass andthey were diagnosed at time of surgery for suspectedbowel hernia (Tagliaabue 2011; Machado & Machado2011; Mandel et al. 2010; Alzaraa 2011). One womanpresented with pelvic pain and was found on laparoscopyto have a rudimentary uterine horn and ovary herniatingthrough the inguinal canal (Al Omari et al. 2011).Coexisting mullerian and renal malformations have beendescribed (Alzaraa 2011; Al Omari et al. 2011).Male and female reproductive systems share commonsteps in early development. Understanding this helps tocomprehend the causes of inguinal ovary. The gonads de-velop from mesothelium on the urogenital ridge. Initiallyin both male and female, the gonads are situated posteriorin the abdominal cavity. After sex differentiation bothovaries and testes descend, but to varying extent. The tes-tes descend to the scrotum via the gubernaculums, a cau-dal remnant of the mesonephric duct that passes throughthe abdominal wall to the labioscrotal swelling. As theembryo grows the gubernaculums remains the same sizecausing the testes to be situated progressively lower down.By the eight month the testes have reached the scrotumand by birth the processus vaginalis at the internal in-guinal ring closes.Contrary to the testes, the ovary descends to a lesser ex-tent because the gubernaculums adheres to the uterus,thus preventing movement. If the gubernaculum fails toattach, the ovary may descend through the inguinal canal.The canal of Nuck is a pouch of peritoneum, analogous tothe processus vaginalis in males, which follows the roundligament from the ovary to the labia via the inguinal canal.is an Open Access article distributed under the terms of the Creative Commonsg/licenses/by/2.0), which permits unrestricted use, distribution, and reproductionroperly cited.Figure 1 a and b, Laparoscopic images of left ovary herniatingthrough the left internal inguinal ring.Josefsson et al. SpringerPlus 2013, 2:545 Page 2 of 2http://www.springerplus.com/content/2/1/545This canal closes within the first year of life. If it fails toclose a hernia may form.ConclusionThis paper describes a rare case of inguinal ovary in awoman who presented with pelvic pain. An inguinal ovarymay occur if the gubernaculum fails to attach to theuterus in fetal life or if the canal of Nuck remains openafter birth.ConsentWritten informed consent was obtained from the patientfor publication of this case report and accompanying im-ages. A copy of the written consent is available for re-view by the Editor-in-Chief of this journal.Additional filesAdditional file 1: Figure S1. Laparoscopic image of uterus and rightovary. Note the absence of left ovary, left ovarian ligament and leftfallopian tube.Additional file 2: Figure S2. Laparoscopic image of left ovary followingits removal from the inguinal canal and mesh repair of the hernia.Competing interestsMette Josefsson, Surajit Mitra, and Sanjay Gupta declare that they have noconflict of interest.Authors’ contributionsPatient was under the care of SM. The idea and planning was done by SM.SG did the mesh repair. MLJ did the literature search and writing of thedraft. All authors contributed to revising the paper. All authors read andapproved the final manuscript.AcknowledgementWe acknowledge the patient who the case report is based on. The patientdid not receive any financial compensation.Author details1Department of Obstetrics and Gynaecology, Lister Hospital, Coreys Mill Lane,Stevenage, Hertfordshire SG1 4AB, UK. 2Department of General Surgery, ListerHospital, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK.Received: 23 September 2013 Accepted: 7 October 2013Published: 17 October 2013ReferencesAl Omari W, Hashimi H, Al Bassam MK (2011) Inguinal uterus, fallopian tube, andovary associated with adult Mayer-Rokitansky-Kuster-Hauser syndrome.Fertil steril 95:1119Alzaraa A (2011) Unusual contents of the femoral hernia. Obstet gynaecol2011:717924Machado NO, Machado NN (2011) Unusual contents of inguinal hernia sac.An approach to management. Surg Sci 2:322–325Mandel DC, Beste T, Hope W (2010) Hernia uterine inguinale: an uncommon causeof pelvic pain in the adult female patient. J mimim invas gyn 17:787–790Tagliaabue F (2011) Indirect inguinal hernia containing fallopian tube, ovary andovarian cyst in adult woman. Chirurigia 24:95–97doi:10.1186/2193-1801-2-545Cite this article as: Josefsson et al.: Inguinal ovary in adult women-casereport and literature review. SpringerPlus 2013 2:545.Submit your manuscript to a journal and beneﬁ t from:7 Convenient online submission7 Rigorous peer review7 Immediate publication on acceptance7 Open access: articles freely available online7 High visibility within the ﬁ eld7 Retaining the copyright to your article    Submit your next manuscript at 7 springeropen.com

Inguinal ovary in adult women-case report and literature review

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Inguinal ovary in adult women-case report and literature review

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