Round ligament varicocoele in pregnancy

Round ligament varicocoele in pregnancy SIR,A 26 year old woman, 33 weeks pregnant, complaining of a painless swelling in her left groin, increasing in size, was admitted under the surgeons for the repair of a left indirect inguinal hernia.At operation she was found to have varicose veins of the round ligament.No inguinal hernia was seen.The veins were ligated.She made an uneventful recovery and delivered normally at term.Varicocoele of the round ligament is rare and presents as a soft reducible swelling in the groin in the second half of pregnancy (Barber and Graham, 1974) usually with vulval varices.Increased intra-abdominal pressure or direct compression by the gravid uterus on the venous drainage of the vulva is thought to be the cause (Royle et al., 1971).There may be discomfort or rupture during labour, causing a vulval haematoma.Injection or surgery is not advised, as the varices usually shrink postpartum, and discomfort may be relieved by local pressure.In this case there were no vulval varices and surgical exploration was undertaken to exclude an inguinal hernia.However, a lump in the inguinal region first appearing after 20 weeks of pregnancy is unlikely to be a hernia because the growing uterus by then occludes the deep inguinal ring, and conservative management may be adopted (Barber and Graham, 1974).