Journal of Surgical Technique and Case Report
Journal of Surgical Technique and Case Report


 
  Table of Contents 
CASE REPORT
Year : 2011  |  Volume : 3  |  Issue : 2  |  Page : 97-98  

Encysted hydrocele of canal of Nuck: A case report with review of literature


Department of Surgery, Cardinal Glennon Children Hospital, Division of Pediatric Surgery, School of Medicine, Saint Louis University, Saint Louis, USA

Date of Web Publication11-Feb-2012

Correspondence Address:
Tarun Kumar
Department of Surgery, Pediatric Surgery, Cardinal Glennon Children Hospital, School of Medicine, Saint Louis University, Saint Louis, Missouri
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2006-8808.92803

Get Permissions

   Abstract 

The canal of Nuck is analogous to a patent processus vaginalis in a male, which normally loses its communication to the peritoneal cavity within the first year of life. Failure of obliteration of this tract can result in a hydrocele. We present a rare case of a 3-year-old girl with right-sided groin swelling over a year, diagnosed as hydrocele of canal of Nuck. Patient underwent surgical exploration and excision of hydrocelea. This entity should be considered in young females presenting with an inguinal swelling.

Keywords: Canal of Nuck, hydrocele, processus vaginalis


How to cite this article:
Janssen K, Klinkner D, Kumar T. Encysted hydrocele of canal of Nuck: A case report with review of literature. J Surg Tech Case Report 2011;3:97-8

How to cite this URL:
Janssen K, Klinkner D, Kumar T. Encysted hydrocele of canal of Nuck: A case report with review of literature. J Surg Tech Case Report [serial online] 2011 [cited 2016 Jun 12];3:97-8. Available from: http://www.jstcr.org/text.asp?2011/3/2/97/92803


   Introduction Top


In females, a peritoneal fold usually accompanies the round ligament as it descends into the labia major through the inguinal canal. Typically, this extension of peritoneum obliterates into a fibrous cord by the first year of life. Failure of obliteration results in a communication with the peritoneal cavity through a persistent Canal of Nuck resulting in inguinal hernia or hydrocele. This is analogous to a patent processus vaginalis in the male.


   Case Report Top


A 3-year-old girl presented to clinic with a nontender palpable swelling in the right inguinal region. On detailed history, the swelling had reduced in size over the past year with no further signs of any regression or progression in size. On physical examination, the swelling was nontender, cystic, and transilluminating. Patient underwent surgical exploration of the swelling through a right inguinal skin crease incision [Figure 1]a and b. After careful dissection through skin, subcutaneous tissues, Scarpa's fascia, and external oblique aponeurosis, the inguinal canal was exposed. The cystic swelling of the cord was identified and isolated. The swelling was confirmed to be an encysted hydrocele of cord with no evidence of associated inguinal hernia. After excision of hydrocele, the fibrous connection toward the deep inguinal ring was suture ligated and rest of the wound was closed in layers. Patient's postoperative follow-up at 6 weeks and 6 months revealed normally healed incision with no recurrence.
Figure 1: (a) Encysted hydrocele of canal of Nuck; (b) Operative finding– isolated cystic sac

Click here to view



   Discussion Top


During fetal development in the male, the testicle descends through the inguinal canal into the scrotum pulling along a sac-like extension of the peritoneum. By the first year of life, this extension condenses into a fibrous cord--the processus vaginalis, preventing the communication of peritoneal cavity with the scrotum. A thin membrane of this original extension remains surrounding the testicle which is named the tunica vaginalis. If this extension of peritoneum fails to close, based on the size of the defect, fluid or abdominal contents may enter the inguinal canal, resulting in a hydrocele or hernia. Congenital hernia or hydrocele, though more common in males, is rarely seen in females. In the female fetal development, round ligament of the uterus descends into the inguinal canal to the labium major. The peritoneal fold that descends the round ligament is named the canal of Nuck. If by the first year of life this communication fails to close, it can also result in an indirect hernia or a hydrocele. [1],[2],[3]

There are three types of a hydrocele of canal of Nuck. The most common type is one with no communication with peritoneal cavity forming an encysted hydrocele along the tract of descent, from the inguinal ring to the vulva. Second type results when there is a persistent communication with the peritoneal cavity. A third type is a combination of the two as a result of the inguinal ring constricting the hydrocele like a belt so that part is communicating and part is enclosed, giving this the name of hour glass type. However, any of these types of hydroceles are extremely rare in females. [4]

The differential diagnosis for an inguinal mass in a female includes indirect hernia, lymphadenopathy, Cold abscess, Bartholin's cyst, post-traumatic hematoma, rarely cystic lymphangioma, neuroblastoma metastasis in groin and ganglion. [1],[5],[6]

In conclusion, a hydrocele of the canal of Nuck though rare should be considered in the differential diagnosis in young females presenting with an inguinal swelling. Establishing a definitive diagnosis on clinical examination is challenging, radiological imaging may assist in diagnosis but surgical exploration is critical for final diagnosis.

 
   References Top

1.Ortenberg J, Collins S, Roth CC. Pediatric Hydrocele and Hernia Surgery. Available from: http://emedicine.medscape.com/article/1015147-overview [Last Updated on 2009 Sep 21].  Back to cited text no. 1
    
2.Park SJ, Lee HK, Hong HS, Kim HC, Kim DH, Park JS, et al. Hydrocele of the canal of Nuck in a girl: Ultrasound and MR appearance. Br J Radiol 2004;77:243-4.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Jedrzejewski G, Stankiewicz A, Wieczorek AP. Uterus and ovary hernia of the canal of Nuck. Pediatr Radiol 2008;38:1257-8.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Counseller VS, Black BM. Hydrocele of the Canal of Nuck: Report of Seventeen Cases. Ann Surg 1941;113:625-30.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Poenaru D, Jacobs DA, Kamal I. Unusual findings in the inguinal canal: A report of four cases. Pediatr Surg Int 1999;15:515-6.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Pandit SK, Rattan KN, Budhiraja S, Solanki RS. Cystic lymphangioma with special reference to rare sites. Indian J Pediatr 2000;67:339-41.  Back to cited text no. 6
[PUBMED]    


    Figures

  [Figure 1]


This article has been cited by
1 Imaging of the Inguinal Canal in Children
Williamson, Z.C. and Epelman, M. and Daneman, A. and Victoria, T. and Chauvin, N. and Oudjhane, K. and Navarro, O.M.
Current Problems in Diagnostic Radiology. 2013; 42(4): 164-179
[Pubmed]
2 Cyst of the canal of Nuck in pediatric patients
Akkoyun, I. and Kucukosmanoglu, I. and Yalinkilinc, E.
North American Journal of Medical Sciences. 2013; 5(6): 353-356
[Pubmed]
3 Imaging of the Inguinal Canal in Children
Zachary C. Williamson,Monica Epelman,Alan Daneman,Teresa Victoria,Nancy Chauvin,Kamaldine Oudjhane,Oscar M. Navarro
Current Problems in Diagnostic Radiology. 2013; 42(4): 164
[Pubmed] | [DOI]
4 Infected Hydrocele of the Canal of Nuck
Parkash Mandhan,Zaid Raouf,Khalid Bhatti
Case Reports in Urology. 2013; 2013: 1
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed2641    
    Printed89    
    Emailed1    
    PDF Downloaded71    
    Comments [Add]    
    Cited by others 4    

Recommend this journal