The Inguinal Herniation of the Ovary in the Newborn: Ultrasound and Color Doppler Ultrasound Findings

Inguinal hernias in the newborn age group are seldom encountered. In the affected female patient, the ovaries, fallopian tubes, and the intestines may settle in the hernia sac. The early diagnosis of torsion in cases in which the ovary is herniated into the inguinal canal is of utmost importance in order to give surgery the chance of reduction and correction. In this paper, a case of an ovarian herniation into the inguinal canal without the presence of torsion is being presented, and the place of US and CDUS in the differential diagnosis of the situation is being discussed. 1. Introduction Inguinal hernias of the newborn era are encountered with a frequency of 1-2%, and the female/male ratio ranges between 1/4 and 1/10 [1]. In 15–20% of the female patients with inguinal hernias, the herniation sac may contain the ovaries and/or the fallopian tubes [2]. Despite the possibility of a spontaneous regression in some cases [3], the presence of ovaries and/or intestinal structures in the inguinal sac decreases the chance of regression, while also increasing the chance of incarceration [4–6]. Ovarian ischemia may arise in case the pedincule of the herniated ovary rotates around itself. Because of this reason, an early diagnosis of the situation is crucial in order to salvage the ovary before an irreversible damage happens. US and CDUS are the methods of priority in this early diagnosis. In this paper, a case of a herniated ovary in a female newborn which was diagnosed with US and CDUS before torsion took place is being presented. 2. Case Report A female newborn of 62 days of age, who was born at the 39th gestational week with a birth weight of 3000？g, was brought to the pediatric outpatient clinic following the discovery of a lump in her right groin by her mother. The baby was anxious and she was in a steady state of intense crying. At physical examination, a tender mass was palpated in the right inguinal region, just above the labium majus. At B-mode US, a 7？mm wide fascial defect and a herniation of tissue material through this defect were detected. The herniated material included cystic structures of which the largest was about 10？mm in diameter, and suggestive of follicular cysts. Thus, this was diagnosed as the right ovary herniated through the inguinal canal (Figure 1). At CDUS, vascular signals were obtained from the ovarian tissue, thus indicating vitality, and leading to a nonconsideration of ovarian torsion (Figure 2). The baby was operated by the pediatric surgeon, and at the operation, an ovary herniated into the right inguinal canal but still not