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<p>Background Inguinal hernias usually contain bowel loops or omentum. Herniation of the uterus and adnexa is exceedingly rare, particularly in adults. Most reported cases occur in infancy due to congenital anomalies such as a persistent canal of Nuck. Uterine incarceration in elderly nulliparous women without prior gynecologic surgery represents an exceptional clinical scenario. Case Presentation A 63-year-old nulliparous woman presented with acute-onset severe left inguinal pain and an irreducible groin mass. Ultrasonography suggested a strangulated inguinal hernia. Emergency surgical exploration revealed the uterus, left ovary, and fallopian tube within the hernia sac all exhibiting ischemic changes along with multiple uterine leiomyomas. In addition, the ovary demonstrated torsion with compromised vascularity. A lower midline laparotomy was performed, and hysterectomy with bilateral salpingo-oophorectomy was carried out in collaboration with gynecology. Standard herniorrhaphy followed. The postoperative course was uneventful, and the patient was discharged on day 2. Conclusion. This case highlights an exceptionally rare presentation of uterine inguinal hernia in an elderly woman, distinguished not only by the patient’s advanced age but also by the occurrence of uterine strangulation with vascular compromise and concurrent ovarian torsion. These unique features underscore the clinical significance of maintaining a high index of suspicion for such unusual hernia contents, as delayed recognition may result in life-threatening complications. Conclusion This case highlights an exceptionally rare presentation of uterine inguinal hernia in an elderly woman, distinguished not only by the patient’s advanced age but also by the occurrence of uterine strangulation with vascular compromise and concurrent ovarian torsion. These unique features underscore the clinical significance of maintaining a high index of suspicion for such unusual hernia contents, as delayed recognition may result in life-threatening complications.</p>

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A Double Trap: Uterine Incarceration and Ovarian Torsion Within a Strangulated Inguinal Hernia in an Elderly Nulliparous Woman

  • 期刊论文

  • 发表日期：

    2025年10月24日

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  • Muhanned Alkhatıb,
  • Hüseyin Garip

摘要

Background Inguinal hernias usually contain bowel loops or omentum. Herniation of the uterus and adnexa is exceedingly rare, particularly in adults. Most reported cases occur in infancy due to congenital anomalies such as a persistent canal of Nuck. Uterine incarceration in elderly nulliparous women without prior gynecologic surgery represents an exceptional clinical scenario. Case Presentation A 63-year-old nulliparous woman presented with acute-onset severe left inguinal pain and an irreducible groin mass. Ultrasonography suggested a strangulated inguinal hernia. Emergency surgical exploration revealed the uterus, left ovary, and fallopian tube within the hernia sac all exhibiting ischemic changes along with multiple uterine leiomyomas. In addition, the ovary demonstrated torsion with compromised vascularity. A lower midline laparotomy was performed, and hysterectomy with bilateral salpingo-oophorectomy was carried out in collaboration with gynecology. Standard herniorrhaphy followed. The postoperative course was uneventful, and the patient was discharged on day 2. Conclusion. This case highlights an exceptionally rare presentation of uterine inguinal hernia in an elderly woman, distinguished not only by the patient’s advanced age but also by the occurrence of uterine strangulation with vascular compromise and concurrent ovarian torsion. These unique features underscore the clinical significance of maintaining a high index of suspicion for such unusual hernia contents, as delayed recognition may result in life-threatening complications. Conclusion This case highlights an exceptionally rare presentation of uterine inguinal hernia in an elderly woman, distinguished not only by the patient’s advanced age but also by the occurrence of uterine strangulation with vascular compromise and concurrent ovarian torsion. These unique features underscore the clinical significance of maintaining a high index of suspicion for such unusual hernia contents, as delayed recognition may result in life-threatening complications.