Groin Swelling (s) in Girls (Differential Diagnosis Gonads)

swel_24a_n.jpg: 2-month-old girl with a large groin swelling which reaches the vulva and squelches on palpation. The operative findings show an opened and spread out large hernia sac with a remarkably wide neck and segments of emerging intestine. Instead of a recognizable adnex, a gonad with two tuberosities is visible. Due to the abnormal gonad without a fallopian tube a testicular feminization has been suspected, and a biopsy of the gonad and an evaluation of the blood kariotype was performed. Testicular tissue with recognizable spermatogones was found in the biopsy of the gonad. swel_24b_n.jpg: Result of evaluation of blood kariotype with a kariotype 46 XY. A testicular feminization is observed once in 200 girls with an inguinal hernia. Therefore, it is important for the early recognition of this malformation to open the hernia sac in every girl, and to look after the adnex, and in case of doubt, to perform a gonadal biopsy.