Abstract
Nuck’s hydroceles, which develop in a protruding part of the parietal peritoneum into the female inguinal canal, are rare abnormalities and a cause of inguinal swelling, mostly resulting in pain. They appear when this evagination of the parietal peritoneum into the inguinal canal fails to obliterate. Our review of the literature on this topic included several case reports and two case series that presented cases of Nuck hydroceles which underwent surgical therapy. We present six consecutive cases of symptomatic hydroceles of Nuck’s canal from September 2016 to January 2020 at the Department of Surgery of Charité Berlin. Several of these patients had a long history of pain and consecutive consultations to outpatient clinics without diagnosis. These patients underwent laparoscopic or conventional excision and if needed simultaneous hernioplasty in our institution. Ultrasonography and/or Magnetic Resonance Imaging were used to display the cystic lesion in the inguinal area, providing the diagnosis of Nuck’s hydrocele. This finding was confirmed intraoperatively and by histopathological review. Ultrasound and magnetic resonance imaging (MRI) captures, intraoperative pictures and video of minimal invasive treatment are provided. Nuck’s hydroceles should be included in the differential diagnosis of an inguinal swelling. We recommend an open approach to external Type 1 Nuck´s hydroceles and a laparoscopic approach to intra-abdominal Type 2 Nuck hydroceles. Complex hydroceles like Type 3 have to be evaluated individually, as they are challenging and the surgical outcome is dependent on the surgeon’s skills. If inguinal channel has been widened by the presence of a Nuck’s hydrocele, a mesh plasty, as performed in hernia surgery, should be considered.
Highlights
IntroductionAs the female fetus develops, the ligamentum rotundum of the uterus descends down to the ipsilateral labia majora, extending through the inguinal canal
The canal of Nuck was first described by the Dutch anatomist Anton Nuck in 1691
Nuck’s hydroceles, which develop in a protruding part of the parietal peritoneum into the female inguinal canal, are rare abnormalities and a cause of inguinal swelling, mostly resulting in pain
Summary
As the female fetus develops, the ligamentum rotundum of the uterus descends down to the ipsilateral labia majora, extending through the inguinal canal. Along with the round ligament, a peritoneal evagination descends, which is known as the canal of Nuck. The processus vaginalis—in women named canal of Nuck—becomes clinically apparent within the 12th week of gestation. It obliterates from the seventh month of gestation to one year of age. Open canals of Nuck present most often in girls before the age of five [1,2,3,4]. Nuck’s hydroceles or inguinal hernias occur in 9–11% of infants born prematurely, as the obliteration of the processus vaginalis begins during pregnancy [5]
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