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

Naomi Shiga, Hiroki Utsunomiya, M. Ishibashi, Hiroki Kurosawa, Mitsuo Nishimoto, Zen Watanabe, Masafumi Toyoshima, Hiroshi Nabeshima, Tadashi Watanabe, Nobuo Yaegashi
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2013 · vol. 29(1) , pp. 168–172 · doi:10.5180/jsgoe.29.168 · W2333050942
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

A quiescent Nuck's hydrocele with endometriosis, initially missed by imaging and presenting after laparoscopic surgery, was successfully treated with open surgery and mesh reinforcement.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 · read from full text ⓘ

This 2013 case report describes a 36-year-old woman with known bilateral endometrial cysts who underwent laparoscopic bilateral ovarian cystectomy and pelvic adhesiolysis, after which she developed increasing left groin pain with apparent enlargement of a lesion. Preoperatively, ultrasonography did not identify the cause, but retrospective review of MRI showed a Nuck’s hydrocele containing endometriosis; subsequent CT demonstrated enhancement consistent with prior contrast exposure. The lesion was removed via open surgery with mesh reinforcement, and histology confirmed Nuck’s hydrocele with endometriosis and inflammation. The main limitation is that it is a single rare case and the proposed mechanism (laparoscopic intra-abdominal pressure revealing quiescent disease) is speculative. This paper is centrally about endometriosis — it reports endometriosis within a rare adult Nuck’s hydrocele that was revealed after laparoscopic surgery.

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Abstract

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 intra-abdominal 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 intra-abdominal 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.
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Abstract

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 intra-abdominal 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 intra-abdominal 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. 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 intra-abdominal 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 intra-abdominal 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. © 2013 Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy Favorites & Alerts Recently viewed articles

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