A Rare Case of a Young Girl With Hydrocele of the Canal of Nuck Mimicking Inguinal Hernia: A Case Report

ABSTRACT

A rare disorder in females called hydrocele of the canal of Nuck is brought on by the processus vaginalis failing to obliterate. We describe a 13‐year‐old girl who developed a type I hydrocele of the canal of Nuck after presenting with left inguino‐labial swelling. Despite misdiagnosis by ultrasound, surgical exploration verified the diagnosis. The hydrocele was completely excised, and the canal at the deep inguinal ring was ligated. The significance of taking this uncommon case into account while making a differential diagnosis for female inguinal swellings is highlighted by this instance.

1. Introduction

The round ligament travels through the inguinal canal with the canal of Nuck, a developmental remnant of the processus vaginalis in females [1, 2]. It usually obliterates within the first year of life, as Anton Nuck initially documented in 1691 [3, 4, 5]. An indirect inguinal hernia or hydrocele of the canal of Nuck (HCN), which is a very uncommon condition in females, could emerge from failure of this obliteration. Because hydroceles are uncommon and have clinical characteristics with inguinal hernias, they can be misdiagnosed. This report details a 13‐year‐old girl's case of HCN, emphasizing the diagnostic challenges and surgical management.

2. Case History and Examination

A 13‐year‐old girl complained of a painless, gradually growing bulge in her left groin that had persisted for 3 months. There was no history of fever, systemic illness, or trauma. The findings on per abdominal examination were normal. Upon local examination, the swelling measured around 4 × 3 cm and was oval, soft, fluctuant, non‐tender, and non‐reducible on the left side. The overlying skin was normal, and there was a negative cough impulse. The right side was examined and found to be normal. Other systems were examined and found to be normal.

3. Differential Diagnosis, Investigations, and Treatment

Following pre‐operative preparation, in which all laboratory and echocardiography results were normal, the patient was diagnosed with a left inguinal hernia as confirmed by the ultrasound and scheduled for an elective herniotomy.

Small part USS that was done showed bowel loops protruding through a defect in the inguinal rim, the defect measuring approximately 6.66 mm. Color doppler interrogation showed preserved vascularity within the herniated bowel loops suggesting no sign of strangulation. Moderate amount of fluid collection was noted around the hernia sac and entire inguinal pouch. It suggested a left‐sided reducible inguinal hernia.

The left inguinal skin incision was used as in Figure 1 while the patient was in a supine position under general anesthesia. After being located next to the round ligament, the hydrocele sac was meticulously dissected as it was seen extending from the internal ring to the labia majora in Figure 2. The sac was excised, and the canal of Nuck was ligated at the deep inguinal ring as shown in Figure 3. When hemostasis was achieved, the wound was closed in layers.

FIGURE 1.

A left inguinal skin crease incision with a hydrocele sac after dissection.

FIGURE 2.

A left inguinal skin crease incision showing a hydrocele sac after mobilization.

FIGURE 3.

Left canal of Nuck with communication to the peritoneum suggesting a communicating hydrocele.

4. Conclusion and Results

Even though it is uncommon in young girls, hydrocele of the canal of Nuck should be taken into account when making a differential diagnosis for inguinal swellings. Excellent outcomes with little recurrence are achieved by early diagnosis with imaging and surgical excision. The majority of postoperative courses are uneventful, and follow‐ups show low rates of recurrence. However, preventing needless treatments or incorrect diagnoses (such as hernias or neoplastic tumors) requires a high index of suspicion and precise imaging.

5. Discussion

The inability of the processus vaginalis, also known as the canal of Nuck, to obliterate during infancy results in the uncommon clinical condition known as hydrocele of the canal of Nuck (HCN) in females [6, 7]. This anatomical structure travels with the round ligament via the inguinal canal to the labia majora and is analogous to the male processus vaginalis [8]. A hydrocele of the canal of Nuck or an indirect inguinal hernia may result from its failure to close.

In women, HCN usually manifests as a soft, cystic swelling in the inguino‐labial area that is either painless or very mildly uncomfortable. Unless it is worsened by an infection or bleeding, which can result in discomfort, redness, and a rapid increase in size, the edema is often irreducible and transluminant. There have also been reported cases of intra‐cystic hemorrhage or infected hydroceles, which might be mistaken for incarcerated hernias or other groin conditions [6, 9, 10].

In females, the round ligament descends with the processus vaginalis throughout fetal development. Usually, it disappears throughout the first year of life. If this obliteration is unsuccessful, peritoneal fluid may build up inside the canal and create a hydrocele [11, 12, 13]. Although this process is less commonly identified in females, it is comparable to that observed in males, which adds to its rarity.

Three types of HCN have been described: Type I (non‐communicating), Type II (communicating), and Type III (combined or hourglass). The type I variant is the most common and typically presents as a painless groin mass that may be mistaken for a hernia, lymphadenopathy, or Bartholin's cyst in females [4, 14].

In making diagnosis, imaging is necessary to distinguish HCN from other inguinal diseases. The first‐line imaging technique is high‐resolution ultrasound (US), which usually reveals a distinct anechoic or hypoechoic cystic lesion medial to the pubic bone [15]. In contrast to hernias that contain intestinal loops, color Doppler scans show no vascular flow within the cyst. Ultrasound done misdiagnosed the case as inguinal hernia possibly due to the rarity of the case or the experience of the radiographer. Despite that it was not done, MRI confirms the diagnosis and helps with surgical planning by displaying hypointense T1 and hyperintense T2 signals, which further define the size of the lesion [13, 16, 17].

Due to its rarity, HCN may be confused with various inguino‐labial masses, including inguinal hernia, Bartholin's cyst, lymphangioma, lipoma, abscess, lymphadenopathy, cystic lymphangioma, and tumors (sarcoma, leiomyoma) [18, 19]. Our case was misdiagnosed as left inguinal hernia.

The definitive management is by surgical excision [20, 21, 22] as what was done in our case. To prevent recurrence, the hydrocele can be carefully removed from the round ligament using open or laparoscopic techniques, and the patent processus vaginalis can be ligated high up close to the deep ring [12, 23] as how it was performed in our case. The diagnosis is usually confirmed by histopathological testing, which reveals a fibrous wall bordered with flattened mesothelial cells [18] which was not done in our case.

Author Contributions

Rajabu Athumani Bakari: conceptualization, data curation, formal analysis, investigation, methodology, project administration, validation, visualization, writing – original draft, writing – review and editing. Alfred Chibwae: conceptualization, data curation, formal analysis, investigation, methodology, validation, visualization, writing – review and editing. Nanyokye Nasira Kidoko: conceptualization, data curation, formal analysis, investigation, methodology, validation, visualization, writing – review and editing. Mwajabu Rashidi Mbaga: conceptualization, data curation, formal analysis, investigation, methodology, validation, visualization, writing – review and editing. Zaitun M. Bokhary: conceptualization, data curation, formal analysis, investigation, methodology, supervision, validation, visualization, writing – review and editing. Victor T. Ngotta: conceptualization, data curation, formal analysis, investigation, methodology, supervision, validation, visualization, writing – review and editing.

Ethics Statement

One uncommon situation that arose during our regular surgical procedures is the subject of this case report. This case report was therefore exempt from our institution's review board's ethical approval process.

Consent

In compliance with the journal's patient consent policy, parents provided written informed consent for this case report to be published.

Conflicts of Interest

The authors declare no conflicts of interest.

Bakari R. A., Chibwae A., Kidoko N. N., Mbaga M. R., Bokhary Z. M., and Ngotta V. T., “A Rare Case of a Young Girl With Hydrocele of the Canal of Nuck Mimicking Inguinal Hernia: A Case Report,” Clinical Case Reports 13, no. 10 (2025): e70987, 10.1002/ccr3.70987.

Data Availability Statement

The corresponding author can provide the data supporting the study's conclusions upon request. Due to ethical and privacy concerns, the data are not publicly accessible.