Cyst of the canal of Nuck in an adult female patient: A case report on surgical management

Introduction: The cyst of the canal of Nuck is a rare cause of inguino-labial swelling in adult women, arising from an obliteration failure of the processus vaginalis during embryological development. Its rarity often leads to misdiagnosis and improper treatment. This article highlights its diagnosis and surgical management.

Case presentation: A 21-year-old woman presented with a two-month history of symptomatic swelling in the right inguino-labial region, after consulting multiple doctors. Various investigations including abdominal ultrasonography, computed tomography, and Magnetic Resonance Imaging revealed multiloculated cystic lesion with thin walls, without communication to the peritoneal cavity. During surgery, an encysted sack was discovered at the external inguinal ring, with no associated hernia. The cyst was ligated high and excised along with the round ligament. The anatomical defect was repaired without using prosthetic mesh. The patient had an uneventful post-operative recovery at six-months follow-up.

Discussion: The encysted hydrocele (Type 1) is the most common among the three types of canal of Nuck hydroceles. This rare entity should be considered in the differential diagnosis of groin masses, even in adult women. Ultrasonography is often used initially, while Magnetic Resonance Imaging is reserved for complex cases. Surgical intervention is essential for both diagnosis and treatment, with dissection extending up to the deep inguinal ring to address any associated hernias. The choice between open or laparoscopic procedures depends on the nature of the defect.

Conclusion: Surgery remains the sole standard therapeutic approach for the management of the cyst of the canal of Nuck.