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Round Ligament Varices Mimicking Inguinal Hernia in Pregnancy: Report of Two Cases
Round ligament varicosity is rare and mainly reported during pregnancy. A systematic review of the literature identified 48 relevant studies reporting a total of 159 cases of round ligament varicosity, 158 of which were associated with pregnancy. Where reported, the mean age of the patients was 30.65 years, and 60.2% were of Asian ethnicity. The laterality of the condition was almost equally distributed, and nearly 50% presented with a painful groin lump. More than 90% of the patients were diagnosed via Doppler ultrasound scan of the affected groin. Conservative management was successful in more than 90% of the patients. Associated maternal complications are rare, with no mortality reported. No fetal complications or loss were reported. Round ligament varicosity can be misdiagnosed as a groin hernia, which may lead to unnecessary surgery during pregnancy. Therefore, increased awareness of this condition among clinicians is important.
Varicosities of the round ligament is a rare condition. Our gravid patient had left inguinal swelling noticeable for 2 weeks and pain on and off. Swelling was reducible and treating surgeon referred patient for ultrasound to rule out inguinal hernia. Round ligament varices present as a unilateral or bilateral inguinal mass with or without pain almost always in pregnant patient. Sonography and Doppler is the best modality to see tortuous venous channels of round ligament compared to bowel or omental contents suggesting of hernia. Differentiating round ligament varices from inguinal hernia is must before any unnecessary surgical intervention and should be kept as differential for unilateral or bilateral inguinal swelling during pregnancy.
Round ligament varicosities are rare and the mass mimics an inguinal hernia. Round ligament varicosities should be considered in the differential diagnosis of a groin swelling of female especially during pregnancy. The diagnosis of round ligament varicosities can be established on gray-scale and color Doppler sonography. We report two cases of round ligament varicosities in a 33-year-old non pregnant woman and a 28-year-old pregnant woman and these patients were diagnosed using ultrasonography.
We also reviewed the literatures about round ligament varicosities including the present cases. Ultrasonography is diagnostic and can prevent unnecessary surgical intervention and associated morbidity.
Purpose:
With a newly described diagnostic pathway, we aim to avoid unnecessary surgical exploration for suspected symptomatic groin hernias in pregnancy.
Methods:
A consecutive series of eighteen pregnant women was referred to our department due to a gradual onset of inguinal swelling and groin ache. In a prospective clinical study, we evaluated these patients clinically and employed grey-scale and colour Doppler sonography (CDS) in all cases--following a newly described pathway. All patients were examined pre- and post-partum by two qualified surgeons. Median follow-up time was 11 months.
Results:
4/18 of the suspected hernias first occurred towards the end of the first, the majority (12/18) in the second, 2/18 in the last trimester and all were suspected after clinical examination only. Most women were referred by their gynaecologists. We found no hernias in any of the women but always noted large varicose veins along the round ligament during CDS. All women gave uncomplicated birth to single children, one by caesarean section. Complaints subsided spontaneously within roughly 2 weeks after delivery. No patient developed a groin hernia until the end of the follow-up period.
Conclusion:
The diagnosis of an inguinal hernia with a first symptomatic onset during pregnancy may be wrong in most cases. Anamnesis and clinical examination must be backed by CDS and round ligament varicosity as an important differential diagnosis must always be considered. Our structured diagnostic pathway helps to easily make the correct diagnosis. Surgical exploration of the groin during pregnancy must be avoided.
Round ligament varicosities during pregnancy are rare, and can easily be mistaken for an inguinal hernia. On physical examination, round ligament varicosities and groin hernia are difficult to distinguish. The diagnosis of round ligament varicosities can be established on gray-scale and color Doppler sonography. We experienced a case of round ligament varicosities in which a 29-year-old woman presented symptoms at 36 weeks gestation. The patient was diagnosed using Doppler sonography, managed with conservative therapy, and had an uncomplicated vaginal delivery at 40 weeks. The symptoms were resolved completely by two weeks postpartum. We report a case of round ligament varicosities that was diagnosed at 36 weeks of gestation with a review of the literature.
A case of uncomplicated round ligament varices mimicking an irreducible inguinal hernia in the third trimester of pregnancy is presented. The clinical and ultrasound features, pathophysiology and the role of conservative management are discussed. Non-surgical treatment led to spontaneous regression after delivery.