1181 Laparoscopic Management of Hernia Uterus Inguinale with Associated Unicornuate Uterus: A Case Report

Video Objective This video demonstrates the laparoscopic management of a surgical emergency due a non-communicating herniated rudimentary uterine horn and ipsilateral torsed adnexa. Setting NA. Interventions This case is a 36-year-old healthy woman undergoing elective oocyte cryopreservation with normal baseline pelvic ultrasounds. On day 7 of oocyte stimulation, an enlarging inguinal mass was identified associated with severe inguinal pain; an incarcerated ovary was suspected. She was taken to the operating room for surgical management. The diagnosis of a Mullerian anomaly was made laparoscopically, noting that she had a right unicornuate uterus with associated normal-appearing right adnexa and ureter. Notably, the left non-communicating rudimentary uterine horn was found herniated through the deep inguinal ring, drawing with it a portion of the left tube and ovary, torsed around its associated pedicle. A left ureter could not be visualized. After decompressing and de-torsing the left inguinal mass, the rudimentary horn, fallopian tube, and necrotic portion of the left ovary were excised using a bipolar sealing device; the inguinal hernia was repaired. The viable left ovarian tissue was retained. A postoperative renal ultrasound confirmed left renal agenesis. Two months later, she successfully underwent oocyte cryopreservation with eggs aspirated from both ovaries. Conclusion Hernia uterus inguinale is a rare condition in which uterine tissue and occasionally adnexa herniate through the inguinal ring. It can present as an asymptomatic palpable mass or rarely as pelvic pain. Most reports have focused on its association with persistent Mullerian duct syndrome, which affects phenotypically male infants. While there are few reports of hernia uterus inguinale occurring in adult females, this case highlights the importance of keeping it in the differential in a patient with an inguinal mass and recognizing the potential for its associated morbidity and the ability to manage it surgically, if needed, through a minimally invasive approach.