Hernia containing ovary is a rare congenital disease with a risk of severe complications: strangulated hernia, ovarian torsion, infertility [1] [2] [3] . The aim of this study was to report our experience of the management of inguinal hernia containing ovary in children.

It was a retrospective study about eleven (11) records of female patients managed in pediatric surgery unit of the Teaching hospital of Bouake during a 2 years period (02 May 2014 au 30th April 2016). Where included in this study, all female child age from 0 day to 15 years presented with ovarian hernia. Exclusion criteria where: all female child age from 0 day to 15 years with other cause of labia majora or inguinal swelling, incomplete records, operated ovarian hernia. We analyzed the age, the gestational age, symptoms, clinical presentation, the hernia site, associated lesions, management, and the outcome. Data where recorded with software word and excel, from charts and operative reports. The median was calculated with Epi info 7.5.

All parents gave their informed consent prior to their inclusion in the study. Additional informed consent was obtained from all individual parent of participant for whom images are included in this article.

The consent of local ethics committee was obtained.

Embryology: Hernia containing ovary is a congenital disease. It results from an incomplete obliteration of processus vaginalis (PV) developed at around the 6th month of fetal development and passes through the inguinal canal up to the labium majora. It is usually obliterated by 8 months of gestations [4] [5] ; these conditions explain the high risk of hernia in preterm [4] . Ovarian herniation through the patent Processus vaginalis named the canal of Nuck, results in an inguinal hernia containing ovary. However, Bowel, omental fat, fluid, fallopian tube, rarely uterus and urinary bladder can also herniate though this [5] [6] and lead to a problem of differential diagnosis.

Socio-demographic aspects: Hernia containing ovary is rare. The prevalence was 7.69% of children’s hernia in our series. Huang reported 4.48% (26 ovarian hernia out of 580 female inguinal hernia cases admitted in Chang Gung Children’s Hospital, Taiwan from 1997 to 2002) [7] . Ovarian hernia is the most frequent inguinal hernia in a female child in our series where it represented 73.33% of female child hernia. Osifo also reported a predominance ovarian hernia with or without fallopian tube (71%) [8] This disease is congenital and can be diagnosed at any age in the childhood [5] [9] [10] .

Diagnosis: The clinical aspect is usually, as observed in our experience, an asymptomatic palpable movable mass in the groin or over the labium majora, painless in absence of incarceration. We did not do pre-operative sonography unlike in literature [1] ; it could help to identify the content of hernia and explore

the contra lateral side. It is an easy accurate pre-operative diagnosis procedure [7] , has ability to evaluate ovary and differentiate hernia containing ovary among hydrocele in the canal of Nuck, a bowel containing hernia, an enlarged lymph node [5] [11] . Oudesluys-Murphy suggests routine ultrasonography mostly in preterm infant girls with an inguinal hernia [12] .

Treatment: The treatment of hernia containing ovary is surgery. Hernia containing ovary should be repair promptly but not in emergency [4] . There is no possibility of spontaneous regression unlike hernia containing bowel [12] . For hernia repair, all the hernia sacs had been opened in our series (Figure 1(b)). Osifo et al. in Nigeria also advised to open hernia sac in female with inguinal hernia to prevent the injury of ovary [8] . In case of strangulated hernia containing ovary, Authors advised a pre operative ultrasonography followed by reduction of hernia and delayed surgery if ovary is normal [2] . If there is a poor vitality of ovary (ultrasonography) or if ultrasonography is not available in emergency, hernia should be emergently repair. Surgeons performed routine open contralateral inguinal exploration to identify a patent processus vaginalis in all children or in selected population like former preterm infants, or children younger than 2 years [13] . However, Open surgery contralateral exploration is decreasing with the use of Laparoscopy which is [13] an alternative increasingly use for treatment of the hernia containing ovary and contra lateral exploration [14] [15] .

In this case, laparoscopy through umbilicus is recommended [4] , but laparoscopy through hernia sac can also be use for contralateral exploration even in infants [4] [16] with less scars and it is cost effective [16] , however Juang et al. reported 2.5% risk of false negative exam other 1291 laparoscopic inguinal hernia evaluation [17] . In low income countries routine pre operative ultrasonography is still a great alternative for patients whose parents cannot afford to pay for laparoscopy.

Health care givers should be aware of the necessity of early surgery and routine contra lateral exploration in young female child with inguinal hernia. Preoperative ultrasonography could be a routine assessment in our practice where pediatric laparoscopy is currently unavailable.

This study has been communicated (oral presentation) at 57^th Conference of West African College of Surgeons (WACS), 26 - 4 March 2017, Ouagadougou, Burkina Faso.

The authors declare that they have no conflict of interest. There are no conflicts of interests between authors/among them.

Rose, N.K., Messou, M., Bertrand, K.J., Patrick, Y.J. and Franck, L.G. (2018) Management of Ovarian Hernia in Children, in Teaching Hospital of Bouaké, Côte d’Ivoire Prise en Charge des Hernies de l’ovaire de l’enfant au CHU de Bouaké, Côte d’Ivoire. Open Journal of Obstetrics and Gynecology, 8, 1438-1444. https://doi.org/10.4236/ojog.2018.813145