The Cyst of the Canal of Nuck: Anatomy, Diagnostic and Treatment of a Very Rare Diagnosis-A Case Report of an Adult Woman and Narrative Review of the Literature

Two indirect sacs and one canal of Nuck in female inguinal hernia: a case report

BACKGROUND

Female inguinal hernias are rare to see. All inguinal hernias in females occur as indirect hernias. A single hernia sac is usually seen, but the occurrence of more than one sac in female indirect inguinal hernias is extremely rare.

CASE PRESENTATION

A 64-year-old female of Kashmiri ethnicity who had multiple comorbidities reported with right groin swelling. She had a diagnosis of a right indirect inguinal hernia. Intraoperatively, one canal of Nuck and two sacs of an indirect type were diagnosed.

CONCLUSION

Occurrence of two hernia sacs of an indirect type and canal of Nuck in female inguinal hernia is an extremely rare occurrence. This is the first case report in the world of a female indirect inguinal hernia being reported having two individual hernia sacs and a single canal of Nuck present. This hernia is named "the Srinagar" hernia after its region of origin.

Laparoscopic Approach To Treat a Hydrocele of the Canal of Nuck: A Case Report

The hydrocele of the canal of Nuck is a rare medical condition that usually affects females during childhood and early adulthood. It is considered the female homolog to the testicular hydrocele in males, as they share similar pathophysiology. The condition is often underreported and considered an incidental finding. On many occasions, it is mistakenly diagnosed and even managed as an inguinal hernia. The hydrocele of the canal of Nuck is usually managed surgically, either by open surgery or laparoscopy. In this case report, we will discuss the hydrocele of the canal of Nuck diagnosed in a young adult female and provide a background, case presentation, and thorough discussion.

Cyst of the Canal of Nuck: a case report

The cyst of the Canal of Nuck, or hydrocele, is a rare pathological condition in the female inguinal region. We present a 44-year-old female with a cystic lesion in the right inguinal area, detailing clinical symptoms, differential diagnosis and imaging findings. Surgical intervention involved complete cyst excision, with no recurrence during the follow-up. This case underscores the importance of accurate diagnosis and targeted surgical treatment for favourable outcomes in managing rare anatomical variations like the Canal of Nuck cyst.

Laparoscopic Versus Open Surgical Management of Hydrocele of the Canal of Nuck: A Retrospective Analysis of 20 Cases

INTRODUCTION

 Hydrocele of the canal of Nuck is a condition that arises due to incomplete obliteration of the processus vaginalis or an abnormal outpouching from the round ligament during fetal development. It usually presents as a painless, rarely painful, groin swelling. The definitive diagnosis for this condition is magnetic resonance imaging. Various management options have been proposed for this condition, including open surgery, transabdominal preperitoneal approach, totally extraperitoneal approach, and a combination of laparoscopic and open surgery. The present study highlights the benefits of the transabdominal preperitoneal approach when compared with the open anterior approach and addresses the intraoperative challenges faced during laparoscopic surgery.

MATERIALS AND METHODS

 The study is a retrospective study inclusive of 20 patients who underwent surgery for the hydrocele of the canal of Nuck from June 2019 to December 2023. Case records of patients were studied for information such as demographic features, type of pathology, the surgery performed, intraoperative challenges encountered, operative time, duration of hospital stay, scores from the visual analog scale pain assessment chart at various intervals, and time taken to return to work. The variables were documented and statistically analyzed.

RESULTS

 The average age group of the study population was 27.8 ± 8.34 years. Of the 20 patients, 10 had undergone a transabdominal preperitoneal approach (Group A), and 10 had undergone an open anterior approach (Group B). Eleven out of 20 patients had an associated inguinal hernia, of which three were identified preoperatively and eight were identified incidentally during surgery. The mean operative time of Group A cases was 97.95 ± 7.54 minutes, while it was 66.3 ± 6.20 minutes for Group B cases. The Mann-Whitney U test showed a statistically significantly lesser operative time for Group B than for Group A (p-value < 0.001). The duration of hospital stays was comparable for the two groups with no significant difference (two days versus 3.8 ± 3.08 days, respectively). When the difference in the means of time taken to return to normal work was compared using the Mann-Whitney U test between Group A and B (6.1 ± 0.87 days and 11.2 ± 1.81 days, respectively), a statistically significant early return to normal work in the former group (p-value = 0.001) was revealed. Similarly, the Mann-Whitney U test when used to compare the median postoperative pain score of both groups at 12-24 hours, 48-72 hours, seven days, and three months showed a significantly lesser pain score among patients of Group A at all intervals (p-value < 0.001, p-value = 0.005, p-value = 0.005, p-value < 0.001, respectively). The incidence of intraoperative challenges, sero-hematoma, and surgical site infection were insignificant in comparison.

CONCLUSION

The transabdominal preperitoneal approach for the hydrocele of the canal of Nuck is ideal as it offers excellent intraoperative delineation of pathology and postoperative outcomes. Prophylactic placement of a mesh in all cases can help prevent a future occurrence of inguinal hernia in these cases.

A Case Report of Female Hydrocele of the Canal of Nuck (Type I): A Diagnostic Challenge and Surgical Solution

The canal of Nuck is an anomaly of the female inguinal canal that can lead to the development of hernias or hydroceles. It is a result of incomplete obliteration of a pouch of the parietal peritoneum that accompanies the round ligament throughout the inguinal canal. This is a case report of a 27-year-old female with hydrocele of the canal of Nuck which was initially misdiagnosed as a reducible right inguinal hernia. Physical examination and ultrasound revealed a right groin 64 × 15 × 36 mm cystic mass extending from the right inguinal region to the labia majora. Right inguinal exploration was performed with an oblique inguinal incision. A cystic lesion measuring 65 × 15 mm was carefully dissected from the round ligament and excised. Histopathological examination confirmed the diagnosis of hydrocele of the canal of Nuck. The patient is doing well after six months with no signs of recurrence on the operated side. The hydrocele of the canal of Nuck, though a rare condition, should always be considered in the differential diagnosis when evaluating inguinolabial swellings in female patients.

Nuck Cyst Presenting as a Recidive Inguinal Hernia: A Rare Case Treated in Plastic Surgery

The canal of Nuck is the female equivalent to the male processus vaginalis. Due to its rarity and the lack of awareness among physicians, a cyst in the canal of Nuck is a seldom-encountered entity in clinical practice and is commonly misdiagnosed. We report on a case of 42-year-old woman who presented with a painful swelling at her right groin and skin hypertrophy of the abdomen. The patient underwent successful open herniorrhaphy with excision of the cyst and mesh repair of the inguinal canal. The results were excellent both in the aesthetic and functional terms. In 1 month, there was a complete recovery with a return to social life. The 3-month healing score was 3 of 13 on the Vancouver Scar Scale. The technique is effective and reproducible. The patient's aesthetic and functional outcomes were excellent. In the following 6 months of follow-up, there were no recurrences or late complications.