Round ligament varices mimicking inguinal hernia during pregnancy

Abstract

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.

A Rare but Noteworthy Diagnosis for “Lumps in the Groin” During Pregnancy: Round Ligament Varices

“…It leaves the pelvis via the deep inguinal ring, passes along the inguinal canal, and terminates distally by breaking into several strands inserted into the labium majora. It consists principally of muscular tissue and some fibrous and areolar tissue and contains veins, arteries, lymphatics, and nerves [ 3 , 5 , 7 , 8 ].…”

“…Furthermore, RLV can be reducible or irreducible compared to a hernia due to the valveless nature of the round ligament varicosities, leading to incomplete emptying. Similar to the inguinal hernia, there is a positive cough impulse with RLV, as increased abdominal pressure with cough results in venous distension [ 1 , 2 , 5 ].…”

“…Given its pathognomonic sonographic findings, RLV can be accurately diagnosed with ultrasonography [ 1 , 5 , 6 ], thus preventing the need for needless and invasive surgical exploration or intervention of the groin, which can result in potential risks/morbidity to the mother and the unborn child. Uncomplicated RLV can be managed conservatively and will undergo spontaneous resolution postpartum [ 2 ].…”