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Mesothelial Cyst of the Round Ligament Misdiagnosed as Irreducible Inguinal Hernia

DOI: 10.1155/2013/408078

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We report the case of a 36-year-old woman who presented with signs and symptoms of an irreducible inguinal hernia. Surgical exploration revealed a mesothelial cyst of the round ligament of the uterus. Mesothelial cysts of the round ligament are rare lesions, frequently masquerading as inguinal hernias, and should be included in the differential diagnosis of any inguinal mass. Clinical findings are those of a groin mass, discomfort, and bulging. Ultrasound and CT scans often demonstrate an aperistaltic cystic mass. Definitive diagnosis is usually made intraoperatively and confirmed histopathologically. 1. Introduction Differential diagnosis of a groin mass includes inguinal and femoral hernias, lymphadenopathy, benign or malignant tumours, saphenous vein varicosities, femoral artery aneurysms, abscesses, dermoid, sebaceous and pilonidal cysts and cystic lymphangiomas. Sex-specific pathologies include an undescended testis or a hydrocele of the spermatic cord in males and cysts, varicosities and endometriosis of the round ligament or herniation of the ovary in females [1]. We present and discuss a case of a rare mesothelial cyst of the uterine round ligament misdiagnosed as irreducible inguinal hernia and review the relevant literature. 2. Case Presentation A 36-year-old, female, caucasian, and multiparous patient presented at the outpatient surgical clinic with a twelve-month history of a right inguinal bulge and discomfort, with progressive worsening of pain over the past 24 hours. Past medical and surgical history was unremarkable. On clinical examination, a relatively firm, smooth inguinal mass was revealed, roughly 4 × 2?cm, medial to Poupart’s ligament, tender to palpation, and protruding when the Valsalva manoeuver was performed. Bowel movements were normal, without vomiting, abdominal distention, or signs of intestinal obstruction. Laboratory tests, and plain abdominal radiographs were within normal range. A preoperative diagnosis of an irreducible right inguinal hernia was made, and the patient consented to surgical treatment. Under general anaesthesia, the right groin was explored. The superficial inguinal ring appeared normal. Following incision of the external oblique aponeurosis, the round ligament was found unusually thin, and a multilobular clear-fluid cystic lesion, approximately 4?cm in diameter, originating from the round ligament, was observed (Figure 1). The lesion was dissected and excised. A concurrent small direct hernia was repaired by the plug-and-patch tension-free technique. The deep inguinal ring was found normal on

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