Kurdistan Journal of Applied Research (KJAR)
Journal homepage: http://www.spu.edu.iq/kjar

ISSN 2411-7684 (print) – 2411-7706 (online)

March 2016 │ Volume 1│ Issue 1 Page 84

KJAR

Case

Report

Encysted Hydrocele of Canal of Nück

Fadhil Ahmmed Mohialdeen1, Muhammed Babakir-Mina1*, Mohammed Ibrahim Mohialdeen

Gubari1

1Department of Community Health, Sulaimani Polytechnic University, Sulaimani, Kurdistan Region, Iraq.

*Corresponding Author: babakir-mina@spu.edu.iq

Received│November 22, 2015 Accepted│January 17, 2016

Abstract

The canal of Nuck is analogous to a patent processus vaginalis in a male, which normally loses its

communication to the peritoneal cavity within the first year of life. Failure of obliteration of this tract can

result in a hydrocele. We present a case of 38 years old lady referred to our surgical unit from Gynecologist

as left obstructed femoral hernia. A fluid filled sac (Encysted Hydrocele of Canal of Nück) with small

indirect inguinal hernia.

Key words: Inguinal hernia, Hydrocele, herniorrhaphy, and Canal of Nück

Introduction

The canal of Nuck in female is analogous to the

processus vaginalis of the male, and it is named

after Anton Nuck, the 17th century Dutch

anatomist. During embryological development the

vaginalis processes is a peritoneal invagination

into the inguinal canal and in the female it

accompanies the round ligament or the

gubernaculum. In both sexes it obliterates

completely by the first year of life. When it fails

to obliterate completely, it can result either in a

congenital hernia or a hydrocele (Jedrzejewski et

al., 2008).

The canal of Nuck is the persistence of the small

processus vaginalis which usually obliterates and

disappears long before birth. It is homologous to

hydrocele of the spermatic cord in male and has

been a rare cause of inguinal canal swelling in

women (Stickel et al., 2004). Normally the

hydrocele of the canal of Nuck presents as a

painless, translucent, irreducible lump in the

groin. However the overlying fascia of external

oblique may not allow transillumination.

Case report

A 38 years- old lady was referred to our surgical

unit from Gynecologist as left obstructed femoral

hernia. On examination there was a tender a

swelling of the left inguinal region, tense,

irreducible, but above the inguinal ligament. She

had history of three years of this swelling. Inguinal

exploration was performed and the findings were

as follows:

A fluid filled sac (Encysted Hydrocele of Canal of

Nück) with small indirect inguinal hernia.

Excision of the sac was performed completely

with the round ligament of the uterus, then

inguinal herniorrhaphy with obliteration and

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KJAR Case Report Encysted Hydrocele of Canal of Nück, Fadhil A M, March 2016

March 2016 │ Volume 1│ Issue 1 Page 85

closure of the internal inguinal ring closure of the

fascial layers was performed successfully without

drain (Figure 1). The patient discharged home on

the same day evening uneventfully.

Figure 1: A) The female hydrocele. B) The cyst with

the round ligament.

Discussion

During fetal development in the male, the testicle

descends through the inguinal canal into the

scrotum pulling along a sac-like extension of the

peritoneum. By the first year of life, this extension

condenses into a fibrous cord—the processus

vaginalis, preventing the communication of

peritoneal cavity with the scrotum. A thin

membrane of this original extension remains

surrounding the testicle which is named the tunica

vaginalis. If this extension of peritoneum fails to

close, based on the size of the defect, fluid or

abdominal contents may enter the inguinal canal,

resulting in a hydrocele or hernia. Congenital

hernia or hydrocele, though more common in

males, is rarely seen in females. In the female fetal

development, round ligament of the uterus

descends into the inguinal canal to the labium

major.

The peritoneal fold that descends the round

ligament is named the canal of Nuck. The canal of

Nuck cyst is thin walled, contains clear fluid and

is lined by cuboidal or flattened mesothelial cells.

Normally the hydrocele of the canal of Nuck

presents as a painless, translucent, irreducible

lump in the groin. However, the overlying fascia

of external oblique may not allow

transillumination.

If by the first year of life this communication fails

to close, it can also result in an indirect hernia or a

hydrocele (Sternberg, 1999). The differential

diagnosis for an inguinal mass in a female includes

indirect hernia, lymphadenopathy, Cold abscess,

Bartholin's cyst, post-traumatic hematoma, rarely

cystic lymphangioma, neuroblastoma metastasis

in groin and ganglion (Pandit et al., 2000, and

Poenaru et al., 1999).

There are three types of a hydrocele of canal of

Nuck. The most common type is one with no

communication with peritoneal cavity forming an

encysted hydrocele along the tract of descent,

from the inguinal ring to the vulva. Second type

results when there is a persistent communication

with the peritoneal cavity. A third type is a

combination of the two as a result of the inguinal

ring constricting the hydrocele like a belt so that

part is communicating and part is enclosed, giving

this the name of hour glass type.

KJAR Case Report Encysted Hydrocele of Canal of Nück, Fadhil A M, March 2016

March 2016 │ Volume 1│ Issue 1 Page 86

However, any of these types of hydroceles are

extremely rare in females (Counseller and Black,

1941). Hydroceles are more common in males

probably because of the differences in migration

of the gonads. A hydrocele can result from either

a persistent patency of the processus vaginalis

with peritoneal communication as in this patient,

or with proximal obliteration at the deep ring with

over-secretion and under-absorption in the distal

segment. The canal of

Conclusions

The curative treatment of this condition is surgical

excision of the cyst with closure of the neck at the

deep ring.

References

Counseller VS, Black BM (1941). Hydrocele of the

Canal of Nuck: Report of Seventeen Cases. Ann

Surg. (113) 625–30.

Jedrzejewski G, Stankiewicz A, Wieczorek AP (2008).

Uterus and ovary hernia of the canal of

Nuck. Pediatr Radiol. (38) 1257–8.

Pandit SK, Rattan KN, Budhiraja S, Solanki RS.

(2000). Cystic lymphangioma with special

reference to rare sites. Indian J Pediatr. (67) 339–

41.

Poenaru D, Jacobs DA, Kamal I (1999). Unusual

findings in the inguinal canal: A report of four

cases. Pediatr Surg Int. (15) 515–6.

Stickel WH and Manner M (2004). Female Hydrocele

(Cyst of the Canal of Nuck) Sonographic

appearance of a Rare and Little-Known Disorder.

MDJ Ultrasound Med (23) 429–32.

Sternberg SS (1999). Diagnostic surgical pathology,

3rd edn. Philadelphia: Lippincott, Williams and

Wilkins.

Encysted Hydrocele of Canal of Nück
Fadhil Ahmmed Mohialdeen1, Muhammed Babakir-Mina1*, Mohammed Ibrahim Mohialdeen Gubari1
Abstract
Introduction
Case report
Discussion
Conclusions
References