Ovary in hernia sac: Prolapsed or a descended gonad?

Background/Purpose: The ligament that lies in the inguinal hernia sac of gi rls is known to be the round ligament and is described as homologous to the male gubernaculum. An ovary in a hernia sac might be assumed to mimic desc ent of the testis. The aim of this study is to determine whether this ligam ent has a role in final ovarian position. Methods: Samples of peritoneal tissues containing the ligament were obtaine d from 15 female infants and children who underwent inguinal hernia repair. Tissue specimens were evaluated through histopathologic and immunohistolog ical analyses. Results: The ligament consists of striated and smooth muscle fibers, abunda nt nerves, and vessels. Estrogen receptors (ER) and progesterone receptors (PR) were identified in submesothelial stromal and smooth muscle cells. No androgen receptors (AR) were found. Conclusions: Although its termination in the processus vaginalis is not fou nd to be consistent with the classical description of the round ligament, l ocalization of ERs and PRs prove that the ligament is a target organ influe nced by hormones. Because the round ligament is supposed to be the female g ubernaculum that has an altered anatomy and localization because of absence of androgen responsiveness, its modified presentation in a processus vagin alis raises the suspicion that the ovary in a hernia sac may not simply be prolapsed, but is a descended gonad. J Pediatr Surg 34:977-980. Copyright ( C) 1999 by W.B. Saunders Company.