Fetal inguinoscrotal hernia: A case series

Inguinoscrotal hernias (ISH) are common in neonates but rarely seen in the fetal period, with only 21 reported cases to date. We present two cases of fetal ISH diagnosed antenatally, each initially misidentified. A 25-year-old woman (G6P3A2) was referred for a solid scrotal mass detected at 34 weeks of gestation and suspected to be teratoma. Repeat Ultrasound (US) at 35 weeks, diagnosed an isolated right-sided inguinoscrotal hernia containing peristaltic bowel loops and mesenteric vascularization without any other anomaly. Patient was born in a peripheral hospital before ultimately undergoing inguinal herniorrhaphy at 10 days of life. In a 27-year-old woman (G1P0), US at 22 weeks revealed bilateral nephromegaly. Biweekly follow-up was performed. At 33 weeks, follow-up US detected a distended rectum containing heterogeneous material. Fetal MRI confirmed bilateral nephromegaly, normal rectal content, and diagnosed a right inguinoscrotal hernia with collapsed bowel loops in the scrotum and an associated left hydrocele. The infant was delivered by cesarean section at 36 weeks at our tertiary pediatric hospital. The infant underwent bilateral nephrectomy and simultaneous bilateral inguinoscrotal hernia repair at 2 months of age. Fetal inguinoscrotal hernia is rare but should be considered in the differential for a fetal scrotal or perineal mass.