Case of mullerian agenesis presenting as bilateral inguinal hernia with left sided irreducibility in a 21 years old female: A rare case report

INTRODUCTION AND IMPORTANCE: Presence of ovary in an inguinal canal in adult female is a rare presentation. Most of the cases are associated with congenital abnormalities of the female genital tract. The incidence of mullerian agenesis decreases with increasing age. The presence of bilateral inguinal hernia with ovaries as a content in an adult female is extremely rare. CASE PRESENTATION: A 21 year old female presented with bilateral groin swelling with associated pain on left side. On evaluation, there was inguinal hernia on both sides, of which left sided was irreducible. The ultrasonography of groin showed uterus and ovary as contents on left sided sac and ovary on the right side. Considering the severe pain and irreducibility on left side, the exploration of bilateral inguinal regions was done. On exploration, the biopsy was taken and the contents were repositioned back into the pelvis. CLINICAL DISCUSSION: The presence of ovary, uterus or both in the inguinal canal is extremely rare in an adult female. Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is characterized by normal secondary sexual character with agenesis of uterus and vagina. Karyotype of individual female is essentially 46XX. Early diagnosis is essential to prevent the complications. The primary treatment of irreducible inguinal hernia is exploration and repositioning the contents back to pelvis if grossly normal and repair of inguinal hernia at earliest. CONCLUSION: A case of bilateral inguinal ovarian hernia with irreducibility in an adult female requires an urgent exploration. Delaying the intervention may result in obstruction, strangulation, and subsequent infertility.