A Double Trap: Uterine Incarceration and Ovarian Torsion Within a Strangulated Inguinal Hernia in an Elderly Nulliparous Woman

Background Inguinal hernias usually contain bowel loops or omentum. Herniation of the uterus and adnexa is exceedingly rare, particularly in adults. Most reported cases occur in infancy due to congenital anomalies such as a persistent canal of Nuck. Uterine incarceration in elderly nulliparous women without prior gynecologic surgery represents an exceptional clinical scenario. Case Presentation A 63-year-old nulliparous woman presented with acute-onset severe left inguinal pain and an irreducible groin mass. Ultrasonography suggested a strangulated inguinal hernia. Emergency surgical exploration revealed the uterus, left ovary, and fallopian tube within the hernia sac all exhibiting ischemic changes along with multiple uterine leiomyomas. In addition, the ovary demonstrated torsion with compromised vascularity. A lower midline laparotomy was performed, and hysterectomy with bilateral salpingo-oophorectomy was carried out in collaboration with gynecology. Standard herniorrhaphy followed. The postoperative course was uneventful, and the patient was discharged on day 2. Conclusion. This case highlights an exceptionally rare presentation of uterine inguinal hernia in an elderly woman, distinguished not only by the patient’s advanced age but also by the occurrence of uterine strangulation with vascular compromise and concurrent ovarian torsion. These unique features underscore the clinical significance of maintaining a high index of suspicion for such unusual hernia contents, as delayed recognition may result in life-threatening complications. Conclusion This case highlights an exceptionally rare presentation of uterine inguinal hernia in an elderly woman, distinguished not only by the patient’s advanced age but also by the occurrence of uterine strangulation with vascular compromise and concurrent ovarian torsion. These unique features underscore the clinical significance of maintaining a high index of suspicion for such unusual hernia contents, as delayed recognition may result in life-threatening complications. Data Availability All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding authors.

Köckerling F, Koch A, Lorenz R (2019) Groin hernias in women-a review of the literature. Front Surg 6:4. https://doi.org/10.3389/fsurg.2019.00004 Ballas K, Kontoulis T, Skouras C, Triantafyllou A, Symeonidis N, Pavlidis T, Marakis G, Sakadamis A (2009) Unusual findings in inguinal hernia surgery: report of 6 rare cases. Hippokratia 13(3):169–171 PMID: 19918306; PMCID: PMC2765295 Halabi M, Alomar A, Khoury K, Abid G, Al-Khatib A, Moussa H (2025) Direct inguinal hernia containing fallopian tube in an adult female: a rare case report. Int J Surg Case Rep 133:111594. https://doi.org/10.1016/j.ijscr.2025.111594 Akıllıoğlu I, Kaymakcı A, Akkoyun I, Güven S, Yücesan Ş, Hiçsönmez A (2013) Inguinal hernias containing the uterus: a case series of 7 female children. J Pediatr Surg 48(10):2157–9. https://doi.org/10.1016/j.jpedsurg.2013.04.027 Ibrahim H, Khaled M, Gates T, Trice H, Sangster G (2016) Irreducible indirect inguinal hernia in premature infant with ectopic uterus and bilateral adnexa. J La State Med Soc 168(6):194–195 (Epub 2016 Dec 15) Fowler CL (2005) Sliding indirect hernia containing both ovaries. J Pediatr Surg 40(9):e13-4. https://doi.org/10.1016/j.jpedsurg.2005.05.066 Dai Y, Qin C, Zhu L, Luo G (2023) Hernia uterine inguinale associated with Mayer-Rokitansky-Küster-Hauser syndrome: three case reports and literature review. Med (Baltim) 102(5):e32802 PMID: 36749224; PMCID: PMC9901970 Kamio M, Nagata T, Yamasaki H, Yoshinaga M, Douchi T (2009) Inguinal hernia containing functioning, rudimentary uterine horn and endometriosis. Obstet Gynecol 113(2 Pt 2):563–566. https://doi.org/10.1097/AOG.0b013e3181942068 Hentati H, Dougaz W, Dziri C (2014) Mesh repair versus non-mesh repair for strangulated inguinal hernia: systematic review with meta-analysis. World J Surg 38(11):2784–90. https://doi.org/10.1007/s00268-014-2710-0 Rodrigues-Gonçalves V, Verdaguer M, Moratal M, Blanco R, Bravo-Salva A, Pereira-Rodíguez JA, López-Cano M (2022) Open emergent groin hernia repair: anterior or posterior approach? J Abdom Wall Surg 1:10586. https://doi.org/10.3389/jaws.2022.10586 Funding The study received no funding. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest The authors have no conflicts of interest to declare. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Alkhatıb, M., Garip, H. A Double Trap: Uterine Incarceration and Ovarian Torsion Within a Strangulated Inguinal Hernia in an Elderly Nulliparous Woman. Indian J Surg (2025). https://doi.org/10.1007/s12262-025-04466-x Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s12262-025-04466-x