Round ligament varicosities diagnosed as inguinal hernia during pregnancy: A case report and series from two regional hospitals in Japan

Abstract

IntroductionRound ligament varicosities (RLV) are not well-known and they are usually caused by pregnancy. Although the groin swelling of RLV mimics an inguinal hernia, it is difficult to distinguish between them through clinical examination alone, and there have been few published reports on this topic, especially from Asia.Case presentationA 37-year-old Japanese woman complained of left groin swelling for 2 weeks at her 28th week of gestation of her first pregnancy. According to a physical examination, she had a soft, painless swelling in the superficial inguinal ring of the left groin. An inguinal hernia was suspected and she was thus scheduled to undergo herniorrhaphy. However, since she had varicosities in the left labia majora, she first underwent color Doppler ultrasonography and a final diagnosis of round ligament varicosities was this made. Her symptoms resolved after delivery of her baby.DiscussionWe herein report 10 cases of RLV in pregnant Japanese women who were initially suspected of having an inguinal hernia. All of them were suspected to suffer from inguinal hernias after a clinical examination by their attending gynecologist. All of them were diagnosed using gray scale and color Doppler ultrasonography, treated with conservative management, and the symptoms resolved in all cases after the delivery.ConclusionThis is the largest report from Asia regarding RLV. To avoid unnecessary surgery in pregnant women, surgeons must be aware of this entity make an accurate diagnosis based of the findings of Doppler ultrasonography.

Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years

“…With regard to long-term consequences we found that with the exception of the coagulopathic patient discussed above, complaints and swelling subsided spontaneously within 4 weeks after childbirth. This supports the results from a previous publication and is in line with other authors' findings [2,7]. Ongoing swelling and complaints for an extended period of time after delivery may therefore warrant further examination to rule out other potentially previously undetected causes in affected women.…”

“…In the present study cohort RLV occurred predominantly in the right groin, followed by left and bilateral manifestations ( Table 3). Other authors found a higher prevalence on the left side [2,7]. The reasons for these variable findings and their underlying cause remain unclear and warrant future exploration.…”

“…Despite numerous publications on the topic, RLV remains a little known and hence rarely considered differential diagnosis of inguinal bulging during pregnancy within the medical professionals' community. Publications are usually limited to case reports [2,6,7] and patient series with short follow-up periods. Potential risk factors, long-term consequences and in particular the possible manifestation of hernias in the area affected during pregnancy have not been analyzed to date and to our knowledge are evaluated in this study for the first time.…”

Inguinal pain during pregnancy, secondary to round ligament varicosities: case report

“…4 Once the suspicion was made, the recommended diagnostic algorithm was performed by Lechner et al and like Mine et al and Yonggang et al two recent Asian studies, present case was treated conservatively and under surveillance, remitting the symptomatology after the resolution of pregnancy in a period no longer than 4 weeks. 6,10,11…”

Spermatic Cord Cyst Presenting as an Incarcerated Inguinal Hernia: An Unusual Case and Literature Review

“…Groin masses can also be confusing in female patients. Round ligament varicosities have been mistaken for inguinal hernias in pregnancy, resulting in unnecessary surgery in a high-risk patient [6]. This further emphasizes the need for accurate interpretation of ultrasonography.…”