Ovary in hernia sac: Prolapsed or a descended gonad?

Background/Purpose: The ligament that lies in the inguinal hernia sac of girls 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 descent of the testis. The aim of this study is to determine whether this ligament has a role in final ovarian position. Methods: Samples of peritoneal tissues containing the ligament were obtained from 15 female infants and children who underwent inguinal hernia repair. Tissue specimens were evaluated through histopathologic and immunohistological analyses. Results: The ligament consists of striated and smooth muscle fibers, abundant 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 found to be consistent with the classical description of the round ligament, localization of ERs and PRs prove that the ligament is a target organ influenced by hormones. Because the round ligament is supposed to be the female gubernaculum that has an altered anatomy and localization because of absence of androgen responsiveness, its modified presentation in a processus vaginalis raises the suspicion that the ovary in a hernia sac may not simply be prolapsed, but is a descended gonad.