Tubo-ovarian abscess projecting into the canal of Nuck
A young female patient admitted as a case of sepsis, present with left iliac fossa mass, had marked leukocytosis, high grade fever.
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A large, multiloculated, relatively contained fluid collection with thick enhancing walls lies centrally in the lower pelvic region extending towards the left side superiorly. The collection extends superiorly and anteriorly being paravesical and compressing the adjacent structures. Extension of the collection is seen violating the left anterior pelvic wall reaching the canal of Nuck and more lateral to the rectus abdominis muscle and into the subcutaneous fat plane with a thick enhancing wall. A small component of the collection is seen mildly protruding along the left femoral vessels.
The case underwent intervention and proved to be tubo-ovarian abscess with anterior extension into the canal of Nuck. The canal of Nuck is an abnormal patent pouch of peritoneum extending anterior to the round ligament of the uterus into the labia majora. It is homologous to a patent processus vaginalis in males which also predisposes to indirect inguinal hernias and hydroceles and cysts of the spermatic cord. Incomplete obliteration of this canal (that simulates patent processus vaginalis) can result in either an inguinal hernia or a hydrocele.