LAPAROSCOPIC APPROACH TO INGUINAL HERNIA WITH INCARCERATED OVARY IN A PATIENT WITH ENDOMETRIAL NEOPLASIA

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Abstract Background To present an infrequent case of inguinal hernia with ovarian content in an adult patient, as well as its minimally invasive approach in the context of an endometrial neoplasia. Material and Methods A 67-year-old female patient presents at the emergency department with a history of progressive weakness and asthenia of months of evolution. Given the finding of iron-deficiency anemia, admission was decided. Computed tomography revealed an endometrial neoplasia associated with a right inguinal hernia, describing a heterogeneous and nonspecific lesion of 8 cm inside it. Further imaging studies were requested by gynecology, establishing the suspicion of endometrial neoplasia with left parametrial invasion. Biopsy confirmed the presence of endometrial adenocarcinoma. Magnetic resonance imaging reported strangulated ovarian content inside the right inguinal canal. Results A joint scheduled surgery was decided, involving laparoscopic radical hysterectomy, selective sentinel lymph node biopsy, and hernioplasty simultaneously. Inguinal hernia repair was performed using trans-abdominal pre-peritoneal hernioplasty (TAPP), with prior excision of the right adnexa for deferred study. Polyvinylidene fluoride (PDVF) mesh was used and fixed with absorbable tackers. The patient was discharged without complications on the second postoperative day. The final surgical specimen showed a low-grade endometrioid carcinoma with mucinous differentiation, clear surgical margins, and two positive nodes (pT2N1). Conclusion Inguinal herniation of the ovary is an uncommon phenomenon. The treatment of this pathology can be safely performed through laparoscopic approach, even in patients with concurrent gynecological neoplasias requiring radical hysterectomy during the same surgical procedure.

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