1. Neonatal ovarian herniation
Intern 郭洧榳

2. Patient profile Name : 李X妮 Chart number : 181024XX
Age of presentation : 23 day
Gender : female
Underlying disease : Nil

3. 2017.03.10 Left inguinal mass found in March 10th morning
Found by the nurse while taking shower at postpartum care center
Fed by breast milk and formula milk
Patient’s parents denied any other associated symptoms
Prenatal ultrasound showed no placenta previa or congenital anomaly
No amniocentesis
No inguinal herniation history
Vaccination was as schedule

4. Birth history G1P1, C/S (mother’s fibromyoma), Apgar score 6→ 9
BBW 2870g(50-75%), BL 50cm(50-75%), HC 35.4cm(>90%)
The mother's prenatal screen:
HbsAg (-) HbeAg (-) VDRL (-) Rubella IgG (-) HIV (-)
Mother's past history :
Hepatitis (-) Syphilis (-) DM (-) HTN (-) TB (-)
Renal disease (-) GBS screen (-)
Prenatal medication: None
4 fibromyomas for 6 years

5. PE 【Neck】: JVE(-), stiffness(-), LAP (-)
【Chest】: Inspection: symmetric expansion, no subcostal retraction
Percussion: resonance
Auscultation: normal BS
【Heart】: Palpation: no heave, no thrill
Percussion: no increase of dullness
Auscultation: RHB, no murmur
【Abdomen】: Inspection: globular, no abdominal distension
Palpation: soft, no organomegaly, pain (-), tenderness (-), rebound (-)
Auscultation: BS: normoactive
left inguinal mass (+) (soft)

6. After admitted
Echo showed bilateral inguinal mass (septal.hypoechoic. Lt: 20*6.7mm. Rt: 23.5*6.8mm)
CT showed left inguinal lesion favoring left ovary inguinal hernia related with engorged venous drainage

12. WBC
7.9
RBC
3.18 Hb
10.5
Hct
30.1
Plt
376
APTT
33.90
MNAPTT
30.6 PT
9.80
PT(MNPT)
11.0
PT(INR)
0.90
BUN 9
CREA
0.25
ALT 10
AST 47
Blast
Pro
Myelo
Meta
Band
Seg 27
Eos 4
Baso 1
Mono 10
Lymph 56
Aty-lym 2
NRBC

13. Operation on 3/14
Operative Findings： left sac: x 5 cm edematous, mildly ischemic, sliding of left fallopian tube and ovary (slightly cyanotic and relieved after reduction.)

14. Neonatal ovarian herniation
Discussion
Neonatal ovarian herniation

17. Introduction
15–20% of the female patients with inguinal hernias, the herniation sac may contain the ovaries and/or the fallopian tubes
Ovarian ischemiamay arise in case the pedincule of the herniated ovary rotates around itself

18. Case information A female newborn of 62 days of age
GA 39 week, birth weight: 3000 g
The baby was anxious and in a steady state of intense crying

19. US and CDUS

20. Discussion
Increased hyaluronic acid induce widening of the processus vaginalis
Processus vaginalis usually gets obliterated by the 8th gestational month
It has been reported in a series of 211 inguinal herniation cases, all of whom were female newborns, that 27% of the cases were premature
The most important complication of inguinal hernias in the pediatric age group is incarceration, which was found in a study to have a frequency of 31%

21. Reference https://www.hindawi.com/journals/crira/2014/281280/