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

Abstract

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.