Direct inguinal hernia containing fallopian tube in an adult female: A rare case report

Abstract

BACKGROUND: Adnexal herniation is an uncommon finding in adult females and is typically associated with indirect inguinal hernias in pediatric or premenopausal patients. The presence of a fallopian tube within a direct inguinal hernia in a postmenopausal woman is exceedingly rare and, to our knowledge, has not been previously reported. CASE PRESENTATION: A 56-year-old postmenopausal female presented with a two-year history of a right groin lump that had recently become irreducible and tender. On physical examination, a firm, non-reducible mass was palpated in the right inguinal region, with no signs of bowel obstruction. Imaging confirmed the presence of a direct inguinal hernia. The patient underwent robotic-assisted transabdominal preperitoneal (TAPP) hernia repair. Intraoperatively, the hernia sac was found to contain omentum and the right fallopian tube. Both structures were viable and were reduced without complication. A standard mesh repair was performed, and the peritoneum was closed. The patient had an uneventful recovery and was discharged on postoperative day one. DISCUSSION: Adnexal structures are rarely encountered within inguinal hernias in adult females, particularly in the context of direct hernias, making preoperative identification challenging. Groin masses in women are more frequently attributed to lymphadenopathy, lipoma, or femoral hernia, with herniation of pelvic organs seldom considered. While adnexal herniation is well-documented in pediatric populations with indirect hernias, its presence within a direct hernia in a postmenopausal patient is exceptionally rare. Recognition of such atypical presentations is essential to avoid intraoperative complications or inadvertent resection of viable organs. In this setting, robotic-assisted repair offers enhanced visualization and precision, facilitating safe dissection and effective management in anatomically complex cases. CONCLUSION: This case represents the first reported instance of a direct inguinal hernia containing a fallopian tube in an adult female. Recognition of atypical hernia contents is crucial, and robotic-assisted repair offers a safe and effective surgical approach.