Inguinal Hernia Containing Uterus and Adnexa in a Female Infant: A Rare Case Report from Libya

Abstract

Inguinal hernias containing reproductive organs represent an exceptionally rare clinical presentation in female infants. While ovarian herniation occurs in approximately 15–20% of female inguinal hernias, concurrent uterine involvement is extraordinarily uncommon, with fewer than 50 cases documented worldwide. This presentation carries significant implications for long-term fertility and reproductive function. A 40-day-old term female infant presented with acute-onset painful right inguinal swelling.  Ultrasonography with colour Doppler assessment revealed an irreducible inguinal hernia containing the right ovary, fallopian tube, and uterine fundus, with preserved vascular perfusion. The anesthetic management employed a rapid sequence induction with ketamine to ensure cardiovascular stability, complemented by rigorous thermoregulatory strategies to maintain neonatal normothermia. Surgical exploration via open inguinal approach confirmed complete herniation of Müllerian structures through a widely patent processus vaginalis. All organs were successfully reduced with meticulous preservation of vascular supply. Postoperative recovery was uneventful except for a superficial wound infection on postoperative day 5, managed successfully with conservative local care without systemic antibiotics. No hernia recurrence was observed at one-month follow-up. This rare presentation underscores the necessity of high clinical suspicion and prompt diagnostic imaging with Doppler assessment in female infants presenting with inguinal swelling. Urgent surgical intervention with organ-preserving techniques and specialized neonatal anesthesia management remains essential to prevent complications, including vascular compromise, torsion, and long-term reproductive morbidity. When managed appropriately, excellent outcomes can be achieved while preserving future fertility potential