Strangulated Femoral Hernia Turned to Be Peritoneal Cyst

Introduction. A peritoneal inclusion cyst is a very rare mesenteric cyst of mesothelial origin usually asymptomatic. A rare case of an 82-year-old white Caucasian female with a femoral hernia containing a large peritoneal inclusion cyst, mimicking strangulated hernia, is presented herein. Case Presentation. The patient was admitted to our hospital suffering from a palpable groin mass on the right, which became painful and caused great discomfort for the last hours. Physical examination revealed a tender and tense, irreducible groin mass. An inguinal operative approach was selected and the mass was found protruding through the femoral ring. After careful dissection it turned out to be a large unilocular cyst, containing serous fluid, probably originating from the peritoneum. McVay procedure was used to reapproximate the femoral ring. Histologic examination showed a peritoneal inclusion cyst. Discussion. Peritoneal inclusion cysts are usually asymptomatic but occasionally present with various, nonspecific symptoms according to their size. Our case highlights that high index of clinical suspicion and careful exploration during repair of a hernia is mandatory in order to reach the correct diagnosis about hernia’s contents. 1. Introduction A peritoneal inclusion cyst is a very rare mesenteric cyst of mesothelial origin occurring in the peritoneal cavity, mostly affecting women in the reproductive age. Unilocular peritoneal inclusion cysts are usually asymptomatic, but occasionally present with various, nonspecific symptoms, which makes correct preoperative diagnosis difficult [1]. They may be attached or lie free in the peritoneal cavity, and occasionally they may involve the round ligament simulating an inguinal hernia. Femoral hernias comprise 6–17% of abdominal wall hernias and usually contain abdominal viscera [2]. We present a rare case of an 82-year-old white female with a femoral hernia containing a large peritoneal inclusion cyst, mimicking strangulated hernia. 2. Case Presentation An 82-year-old white Caucasian female was admitted to our hospital suffering from a palpable groin mass on the right, which appeared two days ago, but for the last hours before admission it became painful and caused great discomfort. The mass was tender and tense on physical examination measuring at least 8？cm on diameter, and it was not reducible. The initial differential diagnosis was either a strangulated femoral or groin hernia. She had no history of other hernias and her laboratory findings were within normal range. Also no history of previous surgery, endometriosis,