Müllerian duct anomalies presenting within an inguinal hernia are exceptionally rare in adult women. We report a case of an irreducible inguinal hernia containing a noncommunicating (type III) rudimentary uterine horn with the ipsilateral fallopian tube and discuss its diagnosis and management. A woman in her 40s (gravida2 para1) presented with a 20-year history of a painless, irreducible mass in her right inguinal region. Physical examination revealed a firm, fixed, nontender solid mass measuring approximately 3 × 4 cm, while pelvic examination was unremarkable. Ultrasonography indicated a unicornuate uterus with a contralateral solid mass, and pelvic magnetic resonance imaging subsequently identified a noncommunicating rudimentary uterine horn with the right fallopian tube herniating into the inguinal canal, which was confirmed during laparoscopic exploration. Laparoscopic transabdominal preperitoneal hernia repair was performed, involving excision of the herniated rudimentary horn and ipsilateral fallopian tube followed by a tension-free repair. The operative time was 95 min with an estimated blood loss of <50 mL, and the postoperative recovery course was uneventful. This case highlights that congenital Müllerian duct anomalies should be considered in the differential diagnosis of irreducible inguinal masses in adult women. Magnetic resonance imaging is the imaging modality of choice, and laparoscopic transabdominal preperitoneal repair enables simultaneous management of the hernia and associated anomalies, facilitating individualized intraoperative decisions regarding the round ligament.
Lan et al. (Wed,) studied this question.