A rare case of inguinal hernia in female

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.

7. Vaginal agenesis

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