Femoral hernia containing incarcerated fallopian tube

Abstract

We read with interest the article entitled ‘‘Presence of a uterine horn and fallopian tube within an indirect sac: report of a rare case’’ by Kokcu et al. [1]. The article describes the clinical case of a woman with sterility as the only relevant symptom in her clinical history, who presented an indirect hernia that contained a fallopian tube and a uterine horn. The author states that sliding hernias of the tube, ovaries, and uterus occur occasionally in newborn female infants, but are rare in young women [1, 2]. Considering the rarity of this event, we present a new case similar to that published by Kokcu and colleagues. A 47-year-old female patient, mother of three children, carrier of an intrauterine device (IUD) and with no relevant medical history, attended the Emergency Service referring to pain and swelling in her right inguinal region. She presented a mass of 3–4 cm in her right femoral region that could not be reduced. The left inguinal region was normal. Further physical exploration and laboratory tests were unremarkable. In accordance with clinical findings that suggested the presence of an incarcerated femoral hernia, emergency surgery was performed. During the surgical procedure, the presence of the hernia was confirmed, and the right fallopian tube was found inside the hernia sac (Fig. 1), with no signs of ischemia (Fig. 2). The sac contents were introduced into the abdomen and the hernia defect was repaired with Lichtenstein’s technique using a polypropylene mesh plug. In our case, the use of open surgery in the femoral region did not lead to the identification of any anatomical abnormality. As in the case reported by Kokcu et al. [1], our patient was a female in her reproductive years, a mother of three healthy children and with no known problems during conception. Around 70% of hernias containing a fallopian tube or an ovary appear in female children under the age of 5 years, and they are secondary to congenital abnormalities of the inguinal or femoral region [3]. Intrauterine exposure to diethylbestrol, a synthetic non-steroidal estrogen used mainly for postcoital contraception, has been related to anatomical malformations of the uterus [4]. The aetiology of these hernias in adult women is not clear; congenital abnormalities of the reproductive organs or previous history of hormone-induced pregnancy have been described as