# Femoral hernia with an incarcerated appendix epiploica mimicking a hydrocele of the canal of Nuck: a case series

## TL;DR

This paper reports two cases where a fatty appendix became trapped in a femoral hernia, mimicking a hydrocele, and highlights how imaging and surgery can correctly diagnose and treat the condition.

## Contribution

The study contributes by identifying a rare cause of inguinal hydrocele and demonstrating the diagnostic value of combining CT and ultrasound.

## Key findings

- Incarcerated appendix epiploica in femoral hernia can mimic hydrocele of the canal of Nuck.
- Computed tomography and ultrasonography together can aid in accurate diagnosis.
- Laparoscopic surgery successfully resolved the issue and confirmed the diagnosis.

## Abstract

In women, inguinal hernias that involve incarceration of intraperitoneal tissues can cause a hydrocele, which can be difficult to distinguish from a hydrocele of the canal of Nuck (HCN). We describe two cases in which an appendix epiploica (AE) became incarcerated in a femoral hernia, causing a hydrocele. In both cases, computed tomography indicated HCN as a differential diagnosis. Ultrasonography revealed protruding adipose tissue within the inguinal hydrocele, which was considered different from HCN. We performed laparoscopic surgery to diagnose, and found the AE incarcerated in femoral hernia. We released the AE, then the inguinal hydrocele completely disappeared. We performed transabdominal preperitoneal repair using mesh, and both patients experienced a favorable postoperative course. Inguinal hydrocele may be due to incarceration of an AE into a femoral hernia. By combining computed tomography and ultrasonography, the appropriate diagnosis and surgical procedure can be selected.