A Case of Quiescent Nuck's Hydrocele with Endometriosis Revealed after Laparoscopic Surgery

Objective: To report a case of a quiescent Nuck's hydrocele with endometriosis revealed after laparoscopic surgery. Design: Case report. Setting: Department of Obstetrics and Gynecology, Tohoku University Hospital. Patient: A 36-year-old woman who was diagnosed with bilateral endometrial cysts underwent laparoscopic surgery. Main Outcome Measures: Ultrasonography, CT, MRI, and histologic examination. Results: We performed a laparoscopic bilateral ovarian cystectomy and pelvic adhesiolysis with ≤ 10 mm Hg intraabdominal pressure. Postoperatively, however, the tumor appeared to be enlarging with increased pain in her left groin. Before the laparoscopic surgery, she was aware of something swelling and then resolving spontaneously; however, she assumed that it was one of the multiple myoma lesions palpable on her abdominal wall. We could not diagnose it as a Nuck's hydrocele by ultrasonography. An MRI taken before laparoscopy was reviewed and found to show a Nuck's hydrocele with endometriosis. An open surgery was planned and the preoperative CT showed a Nuck's hydrocele enhanced with previous contrast agent used in hysterosalpingogram. We removed the Nuck's hydrocele and reinforced the surgical site with mesh. Histological examination confirmed a Nuck's hydrocele with endometriosis and inflammation. Conclusions: A Nuck's hydrocele in an adult female is very rare; to the best of our knowledge, this is the first case revealed following laparoscopic surgery. The Japanese literature contains only 5 case reports of a Nuck's hydrocele with endometriosis. We assume that a quiescent Nuck's hydrocele with endometriosis can be revealed with laparoscopic intraabdominal pressure and imaging enhancement with contrast dye. We recommend that a quiescent inguinal hernia or Nuck's hydrocele should be identified prior to laparoscopic surgery because high laparoscopic intra-abdominal pressure might exacerbate those conditions.