Prenatal Diagnosis of Right Sided Inguinoscrotal Hernia Associated with Severe Growth Restriction in a Fetus with Trisom
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Prenatal Diagnosis of Right Sided Inguinoscrotal Hernia Associated with Severe Growth Restriction in a Fetus with Trisomy 18: A Case Report Vikraman Seneesh Kumar1,2,4
•
Nithya Elango3 • Aditi Dubey1
Received: 31 March 2020 / Accepted: 26 August 2020 Ó Society of Fetal Medicine 2020
Abstract Fetal inguinoscrotal hernia is an uncommon occurence in the prenatal life, and published literature on it is scarce. This is a type of indirect hernia that results from abnormal migration of the small bowel into the scrotum via the patent processus vaginalis. We present a case of prenatal diagnosis of right sided fetal inguinoscrotal hernia, with contralateral hydrocele and severe fetal growth restriction confirmed as Trisomy 18 in subsequently performed chromosomal analysis. The index case presented at 35?2 weeks of gestation with a right sided solid scrotal mass with a regular contour, mixed echogenic texture with a few echo-free areas, a distinctive arterial supply and characteristic peristaltic movements. Fetal demise was noted one week later. The diagnosis was confirmed by postnatal examination. Prenatal diagnosis of fetal inguinoscrotal hernia should be followed up with detailed anatomical assessment and chromosomal analysis if indicated by the presence of additional abnormalities. Isolated cases require surgical repair in the neonatal period to avoid sequelae and complications. Keywords Fetal inguinoscrotal hernia Hydrocele Fetal scrotal mass Trisomy 18 Processus vaginalis Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40556-020-00268-1) contains supplementary material, which is available to authorized users. & Vikraman Seneesh Kumar [email protected] 1
Center for Prenatal Diagnosis and Fetal therapy, ARMC AEGIS Hospital Perinthalmana, Perinthalmana, Malappuram, Kerala, India
2
Almas Hospital, Kottakkal, Malappuram, Kerala, India
3
ARMC Salem, Salem, Tamil Nadu, India
4
Palakkad, India
Introduction Indirect inguinoscrotal hernia is uncommon in fetal life because of a lack of a pressure gradient between the peritoneal and the amniotic cavity [1]. A few cases of inguinoscrotal hernia have been described in the medical literature with diverse characteristics [1–9]. We present a case of a fetal right sided inguinoscrotal hernia with concomitant fetal growth restriction, the chromosomal analysis of which revealed Trisomy 18.
Case Report A 19 year old Indian nullipara was referred to our fetal medicine unit at 35?2 weeks of gestation for expert evaluation because of a fetal scrotal mass suspected in a routine growth scan done eslewhere. Her antenatal course had been uneventful so far. The first trimester and the mid-trimester morphology scans were reported as normal examinations. She did not do undergo any aneuploidy screening tests. The ultrasound examination performed at our fetal medicine unit confirmed a singleton pregnancy with severe fetal growth restriction (estimated fetal weight \ 1st centile), normal mutli-vessel Doppler stu
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