Round ligament varicosity – a rare mimicker of inguinal hernia in pregnancy

Introduction : Round ligament varicosity (RLV) is a rare condition in pregnancy, with approximately 80% of the women being referred by gynaecologists with clinical suspicion of groin hernia. Herein, we report a case of right RLV with a brief review of the literature to raise attention to this condition that can easily be misdiagnosed as a groin hernia thus leading to unnecessary interventions. Case report : A 26-year-old woman presented with dull intermittent pain in the right groin and a lump in the right groin that appeared during the third trimester of the first pregnancy and disappeared after the delivery. The physical exam was normal, so RLV was suspected. During the second pregnancy, she complained of a slight swelling that appeared in the third trimester, accompanied by mild discomfort in the right groin. The physical exam revealed a small lump visible only in a standing position. The US demonstrated multiple dilated and tortuous veins in the inguinal canal that collapsed on pressure and became more prominent on the Valsalva manoeuvre. Doppler US confirmed the venous flow. The exam performed by a vascular surgeon showed multiple dilated pelvic veins and patent blood flow in the major veins of both limbs. Conclusion : The RLV can easily be misdiagnosed as a groin hernia. The exact and timely diagnosis of RLV is critical to avoid unnecessary surgery and diminish the anxiety of the pregnant woman. The differential diagnosis of RLV is relatively straightforward when the surgeon is aware of RLV and the specific US findings.