Hernia Uteri Inguinale in Infancy: A Sonographic Rarity

A 5-month-old female infant presented with a reducible swelling in the left inguinal region that was more prominent during crying. Ultrasonography revealed herniation of the uterus (thick white arrow, Figure 1), left ovary (asterisk, Figure 1), and cervix (red arrow, Figure 2) into the inguinal canal. A little fluid was noted within the hernial sac (thin white arrow, Figure 1). The right ovary appeared normal, was located within the abdominal cavity, and had not herniated into the right inguinal canal. Hernia uteri inguinale results from failure of Müllerian duct fusion and abnormal gubernacular attachment, allowing the uterus and adnexa to herniate through a persistent processus vaginalis (canal of Nuck). Ultrasound with linear probe in the left inguinal region demonstrating a herniated uterus (thick white arrow), ovary (white asterisk), and a little fluid in the hernial sac (thin white arrow). Ultrasound with a linear probe in the left inguinal region showing an elongated cervix (red arrow) traversing a defect in the deep inguinal ring. Such inguinal herniation is predisposed to inadequate fixation of the uterus within the pelvis during embryogenesis, a patent processus vaginalis, and laxity of the uterine and ovarian suspensory ligaments. It is sometimes associated with Müllerian duct fusion anomalies; however, none were found in our case. Although ovarian herniation, with or without the fallopian tube, occurs in 15%–20% of inguinal hernias in female infants, uterine herniation is exceedingly rare. Our patient underwent surgical repair with purse-string closure of the deep inguinal ring, reduction of the uterus and ovary, and fixation of the proximal sac. She was asymptomatic at the 1-month follow-up. Siddhi Chawla: conceptualization, methodology, validation, writing – original draft, writing – review and editing. Girish Prabhakar: project administration, resources, supervision, writing – review and editing. The authors have nothing to report. The authors have nothing to report. The authors have nothing to report. Written informed consent was obtained from the patient's parents. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.