Hernia Uterine Inguinale: An Uncommon Cause of Pelvic Pain in the Adult Female Patient

Hernia uterine inguinale is a rare condition often presenting within the first few years of life as an asymptomatic palpable mass in the inguinal/groin area. This type of hernia contains uterine tissue and may contain oviducts, ovaries, and rarely the bladder. We report a case of a woman with a history of pelvic pain, found to have a rudimentary uterine horn herniating through the internal inguinal ring. A 24-year-old woman presented with noncyclic pelvic pain and irregular menses. Imaging revealed a solid 6- × 2-cm mass posterolateral to the ascending colon at the level of the pelvic brim in addition to absent right kidney and suspected unicornuate uterus. Laparoscopy with excision of the pelvic mass and appendectomy was performed. Surgical findings revealed a right rudimentary uterine horn herniating through the internal inguinal ring, attached to an elongated ovary/and an oviduct tightly tethered to the pelvic side wall. The result of pathologic study was consistent with rudimentary uterine horn, ovary with multiple cortical cysts, normal oviduct, and normal appendix. Hernia uterine inguinale is a rare condition and an even more uncommon cause of pelvic pain, instead presenting as an asymptomatic palpable groin mass early in life. This has been reported most commonly in the literature as both persistent müllerian duct syndrome and male pseudohermaphroditism. It is most often seen in a phenotypically normal male infant having both testes and uterine tissue present. Few cases have been documented to occur in the female sex, the adult patient, or as a cause of pelvic pain. Abdominal and pelvic imaging is useful in the diagnosis of this condition because it may aid in identifying patients with coexisting mullerian malformations. This subset may be at higher risk for hernia uterine inguinale, and, if presenting with complaints of pain or inguinal mass, it should likewise be considered in the differential diagnosis.