Lipomas of the Cord and Round Ligament

Abstract

ObjectiveTo determine the incidence, significance, and anatomy of spermatic cord and round ligament lipomas. MethodsThis was a retrospective review of 280 hernia repairs on 217 patients performed by a single surgeon (M.E.A.) from January 1996 to January 2000. The incidence of cord lipoma and relationship to inguinal hernia were evaluated. Further, when identified at the time of laparoscopic preperitoneal hernia repair, the anatomy of the lipomas was studied both at the time of surgery and again on review of videotapes. ResultsOne hundred ninety-nine laparoscopic and 81 open inguinal hernia repairs were performed on 192 male patients and 25 female patients. Sixty-three lipomas of the cord were identified for an incidence of 22.5%. Overall, 18 cord lipomas were found in groins without hernias, and these were identified before surgery in 10 (2 by physical examination, 7 by groin ultrasound, and 1 by magnetic resonance imaging). The remaining nine were misidentified as a hernia before surgery. Fourteen of these patients presented with groin pain and four were asymptomatic. Forty-five lipomas were associated with hernias and were characterized as a hernia by examination in 43 instances. There were 32 (51%) cord lipomas associated with indirect hernias, 11 (17%) with direct hernias, and 1 each with pantaloon and femoral hernias. Nine lipomas were found in women, seven presenting with groin pain and six found without an associated peritoneal defect. Two patients presented with symptomatic cord lipomas after laparoscopic hernia repair. A lipoma of the cord is herniated fat that appears to originate from the retroperitoneal fat outside and posterior to the internal spermatic fascia and protrudes through the internal ring lateral to the cord. They are generally not visible by transperitoneal inspection unless manually reduced.

Huge, irreducible femoral hernia interpreted as a preperitoneal lipoma in radiological findings

“…Speed (1914) reported the incidence of cord lipoma, encountered equally with both indirect and direct hernias, to be 47.4% [15]. The incidence of cord lipoma is currently estimated at 22.5% of all groin hernias; 23% of them are associated with indirect and 11% with direct hernias [7]. Others evaluate the incidence of cord lipomas as 72.5%, which seems high [16].…”

“…Unlike the high incidence of spermatic cord or round ligament lipomas, medical reports on an incorrect radiological depiction suggesting a retroperitoneal lipoma as an irreducible femoral hernia containing the greater omentum are relatively rare [7]. All patients suffering from inguinal and femoral hernias are qualified for hernioplasty usually by medical investigation, physical examination and ultrasonography of the inguinal canal and femoral triangle.…”

Utilidad del Ultrasonido en el diagnóstico de las hernias inguinales

“…La certeza diagnóstica acorde a la coincidencia entre los hallazgos ultrasonográficos asociados y los quirúrgicos también resultó semejante a la descrita por el Dr. Solis (20) en nuestro centro; así como a la referida en la bibliografía internacional revisada (21,(22)(23)(24)(25)(26)(27) . El nivel de coincidencia entre el diagnóstico ultrasonográfico y quirúrgico de hernia inguinal fue igual, incluso superior, a la mayoría de los estudios publicados en relación al tema, algunos de ellos se exponen en Tabla IV.…”

Missed Lipoma of the Spermatic Cord

“…Lipoma of the cord is the most common benign tumour of the spermatic cord and a common condition of the male population (Lilly and Arregui, 2002).…”