Laparoscopic Inguinal Hernia Repair in a Young Female with Associated Multiple Congenital Defects: A Rare Case

Abstract

Groin hernias are most common among patients presenting with hernia. Males have more predisposition mainly due to anatomy. However, females with groin hernia present with varied abdominal contents including ovaries and fallopian tubes. The worrisome feature of inguinal hernia with ovaries/fallopian tubes as content is torsion. Uncomplicated groin hernia with ovaries as content is managed with conventional laparoscopic or open hernia repair. Young females with groin hernias need to be evaluated thoroughly for features of androgen insensitivity syndrome or any underlying genetic disorder. A 12 years young female presented to our OPD with chief complaints of swelling in the right inguinal region for 6 months. Patient had not achieved menarche yet, however development milestones were found to be normal. On general physical examinations, deformities were noted in the right ear and left upper limb. On local examination, swelling of approximately 3x3 cm was noted in the right inguinal region. An ultrasonography scan of whole abdomen and pelvis which was suggestive of right inguinal hernia containing right ovary with malposition of the right kidney in the pelvis. Consequently, MRI whole abdomen with pelvis confirmed the findings of USG. Patient was taken for laparoscopic inguinal hernia repair. There was right sided indirect inguinal hernia with right ovary as content and a solid mass was also noted in the right pelvic region suggestive of right pelvic kidney. Right ovary was reduced back to the abdomen with transection of the right round ligament and the defect was closed back with interrupted 3’0 Vicryl sutures. Postoperative course was uneventful. Patient was counselled for genetic analysis to rule out any syndrome association. Uncomplicated groin hernia in young females and paediatric age groups with ovarian content can be easily managed with laparoscopic repair. Early intervention should be advised to prevent ovarian torsion and hence long term morbidity.