title: Laparoscopic diagnosis and treatment of a hydrocele of the canal of Nuck extending in the retroperitoneal space: A case report.
abstract: BACKGROUND
  Hydrocele of the canal of Nuck is a rarely encountered entity. We report a case underwent laparoscopic totally extraperitoneal (TEP) treatment for a hydrocele of the canal of Nuck extending in the extraperitoneal space mainly.
  
  
  METHODS
  A 37-year-old woman complained of painless and reducible swelling in her left groin, and referred to our hospital for surgical management against left inguinal hernia with the incarcerated ovary. Ultrasonography and MR images revealed a cystic mass in the retroperitoneal space, and we diagnosed as an unusual type of hydrocele of the canal of Nuck. The patient was scheduled for laparoscopic treatment. Laparoscopic findings on pneumoperitoneum showed an extraperitoneal cystic tumor with no contact with the left ovary. The fascia and peritoneum of the port site were closed, and then an extraperitoneal space was created. The cystic tumor with the round ligament of the uterus was dissected and resected by the TEP technique. The extended deep inguinal ring was repaired with polypropylene mesh. Postoperative course was uneventful.
  
  
  CONCLUSIONS
  Hydrocele of the canal of Nuck in the adult female is a rare condition. The accurate diagnosis of an inguinal hydrocele in a female is seldom made. Laparoscopic examination provides surgeons with information of inguinal swelling accompanied with retroperitoneal cyst, and consecutive treatment by laparoscopic technique, especially TEP, is useful in regard to minimal damage of the peritoneum.
  
  
  CONCLUSIONS
  Laparoscopic diagnosis and TEP treatment offers a useful alternative in selected patients with hydrocele of the canal of Nuck.
authors.affiliation: Department of Surgery, National Hospital Organization Beppu Medical Center, Oita, Japan. Electronic address: tmatsu@beppu.hosp.go.jp.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Department of Surgery, National Hospital Organization Beppu Medical Center, Oita, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Hara
authors.affiliation: Department of Surgery, National Hospital Organization Beppu Medical Center, Oita, Japan.
authors.forename: Teijiro
authors.initials: T
authors.lastname: Hirashita
authors.affiliation: Department of Surgery, National Hospital Organization Beppu Medical Center, Oita, Japan.
authors.forename: Nobuhide
authors.initials: N
authors.lastname: Kubo
authors.affiliation: Department of Surgery, National Hospital Organization Beppu Medical Center, Oita, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Hiroshige
authors.affiliation: Department of Surgery, National Hospital Organization Beppu Medical Center, Oita, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Orita
keywords: Hydrocele; Laparoscopy; TEP; The canal of Nuck