Round Ligament Varicosities Research Articles

A rare cause similar to inguinal hernia in pregnancy: Two cases of round ligament varicosity

Round ligament varicosities (RLVs) which are a very rare cause of inguinal swelling can mimic an inguinal hernia. RLVs should be considered in the differential diagnosis of inguinal swelling in a female, especially during pregnancy. The diagnosis of RLV can be established on Gray-scale with color Doppler sonography, and, if diagnosed correctly, unnecessary intervention may be prevented. We report two cases of round ligament varicosities in a 30-year-old woman at 30-week gestation and 34-year-old woman at 24-week gestation; these patients were diagnosed using ultrasonography and spontaneously resolved after delivery.

Inguinal masses in pregnancy: A case of round ligament varicosty in Ghana

Round ligament varicosities (RLVs) are noted to present diagnostic difficulties for clinicians and are often mistaken to be inguinal hernias. Very few of such cases have been reported globally. To the best of my knowledge, no case on RLV has been reported in Ghana and as such, this case study is likely to be the first reported case in Ghana. A 27-year-old pregnant woman reported to the hospital with complains of bilateral inguinal swelling accompanied with intermittent excruciating pain. The swellings are visible with the woman in the standing position but disappear with the woman lying supine. The swellings are however prominent in the supine position on Valsalva maneuver. The woman was diagnosed with bilateral inguinal hernia and was scheduled for possible surgery after delivery. Dilatation of the vasculature of the round ligament presents as a bulging mass within the inguinal canal, mimicking inguinal hernias when examined physically. The distinction between the two, thus, the RLV and inguinal hernia is established with ultrasound scan examination. Diagnosing RLVs require the use of a color/power Doppler ultrasound machine and also well-trained clinical personnel with sonographic expertise. Ultrasound scan has been recognized to diagnose RLV effectively and to produce a clear-cut distinction from inguinal hernia. Accurate diagnosis of RLV is also essential to avoid unnecessary surgical interventions since the condition is noted to mostly resolve by itself after delivery.

Role of trans-abdominal and trans-perineal venous duplex ultrasound in cases of pelvic congestion syndrome

BackgroundFor evaluation the role of trans-abdominal and trans-perineal venous duplex ultrasound in cases of pelvic congestion syndrome, fifty patients with pelvic congestion syndrome were included in the current research. All were evaluated by trans-abdominal and trans-perineal venous duplex.ResultsAn incompetent left gonadal vein was detected in all cases with a mean diameter (± SD) = 7.9 ± 1.1 mm. The right gonadal vein was incompetent in 4 cases (8%) with a mean diameter (± SD) 5.9 ± 0.4 mm.A refluxing proximal internal iliac vein was detected in 3cases (6%). Left renal vein nutcracker was present in 41cases (82%) while the left common iliac vein compression was present in 3 cases (6%).Vulvoperineal varicosities were seen in all cases {right side = (36%, n = 18), left side = (30%, n = 15), and bilateral = (34%, n = 17)}.Thigh extension of the vulvoperineal varicosities was present in (74%, n = 37).Round ligament varicosities were present in (6%, n = 3).ConclusionsTrans-abdominal and trans-perineal venous duplex offer a simple, noninvasive, and quick technique that can help in an accurate evaluation of the ovarian vein reflux, diameters as well as the presence of vulvoperineal, and round ligament varicosities, Moreover, it is useful in the assessment of the left renal and iliac veins compression.

Round ligament varicosities in 30 weeks' pregnancy: a case report

Round ligament varicosities in 30 weeks' pregnancy: a case report

International guidelines for groin hernia management

International guidelines for groin hernia management

Forty-one cases of round ligament varicosities that are easily misdiagnosed as inguinal hernias.

To demonstrate the benefit and safety of conservative therapy for round ligament varicosities (RLVs) that are easily misdiagnosed as inguinal hernias. We retrospectively analyzed clinical materials of 41 consecutive cases of RLVs diagnosed by ultrasound in a single hospital from January 2011 to December 2015. Misdiagnosis rate, clinical and sonographic features, management after diagnosis and prognosis were recorded. All forty-one cases were pregnant females in their second or third trimester. Twenty-eight cases were first misdiagnosed as inguinal hernias (68.3%). Thirty cases presented as reducible swelling in the inguinal area (73.2%), and twenty-five of which were painful (61.0%). Four cases only felt pain in the inguinal area without swelling (9.7%). Seven cases had no obvious discomfort (17.1%). All cases were diagnosed as RLVs by gray-scale and color Doppler ultrasonography and justified a wait-and-see strategy. Thirty-seven cases were followed until total recovery after delivery (follow-up rate 90.2%). Swelling with or without pain disappeared spontaneously postpartum. RLVs are easily misdiagnosed as inguinal hernias and color Doppler of the inguinal area is the best examination for making the correct diagnosis. Conservative therapy for RLV is beneficial and safe when assured by color Doppler.

Gebelikte inguinal herniyi taklit eden round ligament varisleri: Olgu sunumu

Gebelikte inguinal herniyi taklit eden round ligament varisleri: Olgu sunumu

Round Ligament Varicosities in Pregnancy

Round Ligament Varicosities in Pregnancy

Complications of Round Ligament Varicosities

Complications of Round Ligament Varicosities

Round ligament varicosities: a rare cause of groin swelling in pregnancy

Round ligament varicosities (RLVs) are rare, and only occur in pregnancy. The swelling due to RLVs mimics an inguinal hernia and generally resolves spontaneously after delivery. Distinguishing between varicosities and hernias is critical to avoid unnecessary surgeries on pregnant women. We aimed to determine the significance of RLVs during pregnancy and to review and describe their clinical and sonographic characteristics. All patients were diagnosed by gray scale and color Doppler ultrasonography, managed conservatively, and RLVs regressed spontaneously postpartum.

Round ligament varicosities associated with uterine varicosities in pregnancy: A case report

Round ligament varicosities associated with uterine varicosities are rare during pregnancy. We report the case of a pregnant woman with a painful mass in her left groin at 32 weeks' gestation. Ultrasound revealed multiple distended veins within the left round ligament and over the uterus. The patient was treated by close observation and had a vaginal delivery of a healthy baby.

ROUND LIGAMENT VARICOSITY IN PREGNANCY

Groin swelling in pregnancy can give rise to various diagnostic dilemmas. Inguinal hernia not uncommonly may present for the first time in pregnancy because of increase in intraabdominal pressure. It is 10 times less frequent in women than in men. The reported incidence is 1 in 3000. The other differential diagnosis including femoral hernia, enlarged lymph nodes, vascular aneurysm and subcutaneous lipoma. Congestion of the pelvic and iliac veins may give rise to round ligament varicosities mimicking inguinal hernia. The distinction between the two is difficulty clinically as symptoms and signs are similar. Ultrasound has proved to be a useful tool for differentiating round ligament varicosities from an inguinal hernia. The characteristic ultrasound picture includes a prominent venous plexus with dilated draining veins and typical bag of worms appearance. Round ligament varices require close monitoring during pregnancy as it can lead to rupture of varices or acute variceal thrombosis in peripartum period. This case highlights the potential difficulty in diagnosing inguinal swelling clinically in pregnancy. Ultrasonography can however clinch the diagnosis and prevent unnecessary surgery and its associated morbidity. Bilateral inguinal swelling is gravid state is not a common occurrence is obstetric practice. Bilateral round ligament varicosities may be mistaken for inguinal hernias in gravid patients because these conditions have similar presentations. It is very critical to differentiate between varicosities and hernias to avoid performing unnecessary surgery.

カラードプラ超音波検査により診断し得た子宮円索静脈瘤の2例

カラードプラ超音波検査により診断し得た子宮円索静脈瘤の2例

Round ligament varicosity: a rare cause of inguinal swelling

We report a case series of three pregnant patients who presented with inguinal mass that were found to be round ligament varicosities. The diagnosis and management of this rare condition are discussed. A review of the literature is presented.

Round ligament varicosities mimicking inguinal hernia in pregnancy

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.

Bilateral round ligament varicosities mimicking an inguinal hernia in pregnancy: Case report

A 22-year-old pregnant woman presented with a painful swelling in the right groin. Sonography was performed to confirm a presumptive diagnosis of inguinal hernia based on physical examination. Gray-scale sonography examination revealed bilateral inguinal cystic lesion expanding with the Valsalva maneuver. Color Doppler imaging demonstrated multiple prominent vessels with retrograde venous flow during Valsalva maneuver. Bilateral round ligament varicosities were diagnosed and inguinal hernia was excluded by sonographic findings. Round ligament varicosities should be considered in the differential diagnosis of groin swelling during pregnancy.

A soft tissue groin mass

Groin lump in a pregnant womanDiagnosisVaricosities of the round ligamentDiscussionRound ligament varicosities are engorged pelvic veins, thathave extended into the inguinal canal around the roundligament. These typically occur during and after the secondtrimester of pregnancy and present as soft and non-tendermasses in the inguinal region.The most common differential diagnosis of a groin lumpwith this presentation is an inguinal hernia [1–4]. Althoughinguinal hernias are uncommon in women, increased intra-abdominal pressure during pregnancy can lead to thiscondition. Its incidence in pregnancy has been reported tobe 1 in 1,000–3,000 [5]. Distinguishing round ligamentvaricosities from inguinal hernia on clinical grounds can bedifficult and is often not possible as both have a similarlocation, can be reducible or irreducible and can transmitcough impulses [1–4]. Other possible causes of an inguinalmass include femoral hernia, persistent embryonic remnants(cyst of the canal of Nuck), lymphadenopathy, soft tissuetumour and abscess formation.In this case the history of sudden onset in the thirdtrimester of pregnancy suggested the diagnosis, but thecorrect diagnosis was confirmed by the typical appearanceson Doppler ultrasound [6]. Many of the other possiblediagnoses, such as lymphadenopathy, hernias, cysts andabscess, also have characteristic ultrasound appearances,while the absence of a solid component to the mass wouldmake soft tissue tumour unlikely. Round ligament varicos-ities appear as large dilated spaces on ultrasound, locatedwithin the inguinal canal and passing through the deepinguinal ring (lateral to the inferior epigastric vessels). Inour case the varicosities also passed through the superficialring. Colour or power Doppler confirms the presence ofblood flow within the veins comprising the varicocoele,and this characteristically augments with the Valsalvamanoeuvre [7]. The inferior epigastric vessels are easily seenon ultrasound and lie immediately medial to the deepinguinal ring. As with investigation of inguinal hernia, theyprovide a landmark for the sonographer. The superficialinguinal ring lies immediately lateral to the pubic tubercle,which provides a useful bony landmark. Although the veinsare associated with the round ligament of the uterus, theligament itself was not visualised. In the normal femaleinguinal canal, the veins and artery characteristically markthe course of the round ligament on ultrasound.Round ligament varicosities are an accentuation of aphysiological process and correct diagnosis is imperative toavoid unnecessary surgery. They are managed conserva-tively and resolve in the post-partum period. The resolutionpost-partum helps to exclude other causes of vascular mass,such as an arterial-venous malformation, although the

A case of round ligament varicosities during pregnancy

Estimated incidence of round ligament varicosities in pregnancy is not known and often times it is confused with inguinal hernia due to their clinical similarities. When a patient is presented with inguinal mass especially in association with varicosity in the genital region or lower extremity, round ligament varicosity must be considered as a plausible diagnosis. Depiction of “bag of worms” on color Doppler ultrasonography is diagnostic of the round ligament varicosity and it is known to resolve spontaneously following delivery. We report a case of round ligament varicosities that was diagnosed at 29 weeks of gestation with a brief review of the literatures.

Bilateral round ligament varicosities mimicking inguinal hernia during pregnancy

Bilateral round ligament varicosities mimicking inguinal hernia during pregnancy

Bilateral round ligament varicosities mimicking inguinal hernia during pregnancy

Round ligament varicosities during pregnancy have not been reported extensively. The swelling mimics an inguinal hernia and should be considered in the differential diagnosis of a groin swelling during pregnancy. We report a case of a pregnant woman with bilateral round ligament varicosities. At 22 weeks of pregnancy she was operated on based on the clinical suspicion of a painful inguinal hernia on the right side. Surgical exploration revealed varicosities of the round ligament, and resection was performed. Four weeks later the same diagnosis was made by duplex sonography of a painful swelling in the left groin. Increased pain necessitated surgical exploration and resection of the varicosities on the left side. The postoperative course on both sides was uneventful and without pain during the rest of her pregnancy, during labor or post partum.