Ovary as Hernial Content: A Unique Presentation of Inguinal Hernia in Infant Twins

Background: Gynaecological structures such as the ovaries, fallopian tubes, ligaments and uterus are rarely encountered inside a hernial sac. The prevalence of groin hernias containing parts of female genitalia remains unknown. Ovary-containing inguinal hernias are rare, comprising approximately 6–7% of paediatric inguinal hernias. Occurrence in monozygotic twins is exceptionally uncommon and has not been reported previously. Case Presentation: This report a unique case of 4-month-old monozygotic female twins who presented with unilateral, non-reducible groin swellings. Ultrasonography confirmed herniation of ovaries and fallopian tubes in both cases. Prompt laparoscopic herniotomy using the Percutaneous Internal Ring Suturing (PIRS) technique was performed. Intraoperatively, viable adnexal structures were identified without torsion or ischemia. Both patients had uneventful postoperative recovery. Ovary-containing hernias account for approximately 6–7% of female paediatric inguinal hernias. The simultaneous occurrence in twins suggests a potential genetic or embryological predisposition. Prompt surgical repair is essential to avoid torsion and preserve fertility. Conclusion: This is the first documented case of monozygotic twins with ovary-containing inguinal hernias. It highlights the importance of early imaging, high clinical suspicion, and minimally invasive surgical intervention in female infants presenting with groin swellings. The simultaneous presentation in twins raises the possibility of a shared genetic or developmental predisposition, warranting further study.