INTERESTING CASE STUDY

Mrs. Minimalar

24year old Primi from Villukuri

Admitted with complaints of lower

abdominal pain since 2 days.

She is a primi with 4 months amenorrhoea

LMP 17/09/2012

EDC 24/06/2013

H/O Presenting Complaints Patient was referred from local hospital, as a Primi – 16 weeks gestation with a/c abdominal pain 2 days.

Diffuse pain

Associated with vomiting

Regular ANC and was immunized

Past & family H/O No similar illness in pastCongenital anomalies present in family

Marital H/O Married since 7 monthsNon consanguinous marriage

Menstural H/O Regular cycleLMP – 17/09/2012

ExaminationO/E - Thin built

- Conscious & well oriented- Afebrile- No pallor / No oedema- Speech stammering- Mouth – uvula absent- hands & feet – congenital wasting

+ deformity of hand & feet

Vitals – stableCVSRs NAD

Per Abdominal Examination Tenderness iliac fossaswelling left inguinal region3x2cmNon – reducibleNo cough impluseTransilluminant

Uterus16 weeksFH good

Investigation

All Haematological investigations – WNL

USSRevealed – single viable foetus

- 16 weeks- NL for date

USS of inguinal region

A large thinwalled simple cyst containing clear fluid in left inguinal region.

It extended from level of deep inguinal region to superficial inguinal ring just lateral to symphysis pubis.

Right ovary enlarged with vascularity

Left ovary seen separate from the cyst.

What can this be ?

Differential DiagnosisInguinal HerniaFemoral HerniaEnlarged lymphnodesSoft tissue tumour

LipomaLeiomyomaEndometriosis of round Ligament

Vascular abnormality like – Arterial + venous aneurysmsRarely – hydrocoele of canal of nuck Ganglion cystPara spinal abscess

DiscussionRare cause of inguinal swelling in women

Only 400 reported cases

Female counterpart of hydrocoele of spermatic cord

Rare developmental disorder

Anatomy In male foetus an evagination of the parietal peritoneumThe processus vaginalis accompanies the testis as it descends into the scrotum

The same finger like processus vaginalis named the canal of Nuck follows the round ligament of uterus as it passes through the female inguinal canal

Normally this peritoneal evagination undergoes obliteration soon after birth in both sexes or within 1 year

Failure to achieve complete obliteration

Partial proximal obliteration leaves the distal portion of processus vaginalis open cyst of canal of Nuck

DiagnosisBased on clinical findings

•Painless swelling•Moderately fluctuant inguinal mass•Irreducible•Transilluminant•No A/c abdominal symptoms

Investigation

Choice Ultra sound scan MRI

Treatment of choice

Surgical resection of hydrocoele, and ligation of neck of processus vaginalis

Sonographically guided aspiration temporarily

Risk of contralateral inguinal hernia

Conclusion Rare developmental disorder

DD for groin tumour in females

USS – investigation of choice

Concomitant inguinal hernia may be there

Surgical excision curative

Temporary cure – USS guided aspiration.

Thank you