PMC5385783_01
On ultrasonogram; A to F showing sequential images of herniation of uterus and bilateral ovary in left inguinal region in a 3-month-old female infant having left inguinal and left valva swelling. (A) Urinary bladder (white star) and laterally uterus (white arrow). (B) Herniation of uterus through anterior abdominal wall (blue arrow). (C, D) Uterus and one ovary in the herniated sac at labia majora region. (E, F) Both ovaries (yellow stars) having peripherally oriented follicles
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F1
Hence, USG findings were suggestive of indirect inguinal hernia containing uterus and bilateral ovary [Figure 1].
Color Doppler images show normal arterial flow right (A) and left side ovary (B) present in the herniated sac at left labial region
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F2
At colour Doppler ultrasound normal arterial vascularity was detected in bilateral ovary, suggesting viable ovarian tissue [Figure 2].
PMC5385783_02
(A-D) Ultrasound of left inguinoscrotal region with high frequency transducer in 1-month-old male infant showing left inguinal hernia extending into left scrotum containing bowel loop with feature indicative of incarceration. (A) Right side ultrasound image shows normally placed right testis in right scrotal sac, left side ultrasound image shows dilated fluid fill bowel loop in left scrotal sac, displacing left testis anteriorly. (B) Ultrasound image shows dilated fluid filled small bowel loop (arrow) with mild fluid around the bowel (white star) suggestive of incarceration of herniated bowel. (C, D) Ultrasound image at higher level in scrotum show bowel loop (yellow star) along with its echogenic mesentery (black arrow), normal vascularity in mesentery sufficient to rule out ischemia of herniated bowel
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F3
Ultrasonography examination showed dilated fluid-filled bowel loop in inguinoscrotal region [Figure 3] along with reduced peristaltic activity with mild amount of fluid in the herniated sac cavity around bowel and anterior laterally pushed left testis; the findings were suggestive of incarcerated hernia as peristalitic activity present in herniated loop was sufficient to rule out strangulation.
PMC5385783_03
(A-D) Ultrasound with high frequency transducer probe in 5-day-old female neonate for asymptomatic right inguinal region swelling show viable right ovary with attached ovarian ligament. (A) Transverse ultrasound scan at right inguinal region swelling show oval shape hypoechoic structure (white arrow) contain small peripheral follicles suggest appearance of ovary herniated into right inguinal canal, ovary attach to hypoechoic pedicle (black arrow). (B, C) Color Doppler study shows prominent vessels with arterial flow with PSV approximately50-60 cm/s in ovarian pedicle, having normal spectral wave form. (D) Ultrasound scan in pelvic region show uterus with visible echogenic endometrium and left ovary in normal position
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F4
Thus, this was diagnosed as the right ovary herniated through the inguinal canal [Figure 4].