Canal of Nuck hydrocele in elderly female with cirrhosis: A case report and review of literature

Hydrocele of the Canal of Nuck is a rare inguinal-scrotal swelling that occurs primarily as a chronic painful lump in childhood or in young women. Here, we present a rare case of the same, presenting at an extreme of age and with a short history. An 85-year-old female patient presented with a progressive inguinal swelling for 2 months in a known case of decompensated cirrhosis of liver in form of ascites and portal cavernoma. It was large, nontender, cystic, irreducible, and had negative cough impulse. Diagnosis was confirmed on clinical and radiological grounds. Patient was managed with intravenous (IV) albumin (As it reduces likelihood of paracentesis associated circulatory dysfunction) and large volume paracentesis for ascites before surgical intervention. After confirming the absence of ascitic fluid patient underwent surgery with removal of large size hydrocele of Canal of Nuck and was managed postoperatively with IV albumin. Surgery is the mainstay of treatment in symptomatic cases. Thus, clinicians need to have a high index of suspicion for liver failure when patient is undergoing surgery in case of chronic liver disease, considering the variable age of presentation and rarity of this condition.