Unusual Contents of an Inguinal Hernia

Introduction: Abdominal hernias are commonly seen in the emergency department. One retrospective study involving 330 cases only found two ovarian hernias. Ovarian hernias occur in less than 1% of hernias, given it’s rarity, optimal management is unknown. Case: 56 year old hispanic female with history of c-section presented with one week of constant, sharp LLQ abdominal pain with episodes of increased intensity. Pain was moderate, radiating to the left thigh. Improved with Ibuprofen. Nothing made it worse. Associated with nausea. All reviews of systems otherwise negative. Vitals were within normal ranges. The patient was in no distress, her abdominal exam was limited due to BMI of 41.2 kg/m2, but did have LLQ tenderness with voluntary guarding, no rebound or peritoneal signs. Work-up was negative for UTI, pregnancy, and labs were unremarkable. CT abd/pelvis with IV contrast was performed and demonstrated a left ovary which was herniating through the left inguinal canal. Transvaginal US was subsequently performed to evaluate for ischemia/torsion which demonstrated the ovary within the inguinal canal itself. A bedside hernia reduction was performed by placing the patient in Trendelenburg position. Discussion: Currently there are no standard treatment guidelines for the emergency medicine practitioner. Our bedside reduction followed by surgical repair was similar to the case previously published. While we did proceed with urgent surgery it can likely be performed outpatient. Conclusion: In the setting of an ovary herniating through the inguinal canal, and in the absence of complications, bedside reduction should be strongly considered.