Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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I.M. Daoud and K. Dunn
with a herniogram [ 24 , 25 ]. The one difference in imaging is on CT
examination, where an inguinal cord lipoma is mesenteric fat passing
through the inguinal ring, and an indirect inguinal hernia often has a
radiographically visible sac [ 20 ]. There is limited literature on the
diagnosis of inguinal cord lipoma alone, as it is mostly found on surgical
repair of an inguinal hernia. This is an important diagnosis to
consider during the time of herniorrhaphy because an undiagnosed and
untreated cord lipoma may cause groin pain to persist or predispose
the patient to a recurrent hernia after repair. Exploration of the cord,
therefore, should take place if initial laparoscopic inspection is negative
for hernia and the patient has a convincing history consistent with
hernia-type symptoms [ 19 ].
Treatment Though the lipoma, in most instances, has no pathological
changes suggesting it is a true lipoma, but rather an extension of
extraperitoneal fat protruding through the inguinal canal, it may still
cause hernia-type symptoms warranting treatment [ 21 ]. The distinction
between indirect inguinal hernias and inguinal cord lipomas is not necessarily
important; if they are symptomatic, they both should be treated
with open or laparoscopic surgical repair [ 20 ].
Conclusion
Inguinal hernias, whether occult or obvious, and lipomas of the spermatic
cord or round ligament are important etiologies to consider in the
diagnosis of groin pain. A supportive clinical history and a well-performed
physical exam can diagnose inguinal hernias the majority of the
time. Imaging may be useful when there is a history indicative of hernia
but an equivocal physical exam. Given the multiple imaging modalities
available with different benefit and risk profiles, the choice of MRI, CT,
or ultrasound is often provider specific. MRI, however, has recently
been shown as potentially the best modality for diagnosis of occult hernia.
Additionally, diagnostic laparoscopy serves an important purpose in
diagnosing the occult hernia. This is especially the case in women with
chronic pelvic pain, in whom it is beneficial because diagnosis and
repair can be performed at the same time. Lipomas of the cord and round
ligament cause similar pain to that of a hernia and should be diagnosed
and treated in the same fashion. In all cases, when a patient is symptomatic
from a hernia or lipoma of the cord, it should be repaired via a