Journal of Clinical and Diagnostic Research. 2022 Apr, Vol-16(4): PD06-PD07 6 6 DOI: 10.7860/JCDR/2022/53458.16285 Case Report Surgery Section Giant Groin Lipoma Deluding as Hernia: A Case Report CASE REPORT A 36-year-old female presented with a swelling in left inguinal region for 6 months that was progressively increasing in size, associated with dragging pain and irreducibility. She gave history of two cesarean sections done 3 years and 5 years back. Patient was not taking any treatment for the same complaints and there was no significant family history. On examination, a 12 cm Pfannenstiel scar was present 4 cm above the pubic symphysis. A firm, tender swelling of size 6x5 cm was noted in left groin region with no overlying skin discolouration and was extending up to pubic symphysis. There was no evidence of cough impulse or sign of reducibility. A clinical diagnosis of incisional hernia was made. Ultrasound abdomen was suggestive of a 14×6 cm hyperechoic homogenous lesion without any defect in anterior abdominal wall. Computerised Tomography (CT) scan of abdomen showed a circumscribed, low attenuation mass of size 15×8 cm, suggestive of lipoma, superficial to left external oblique aponeurosis, without any defect in anterior abdominal wall [Table/ Fig-1a,b]. Patient was subjected to inguinal exploration under regional anesthesia. A lipomatous lesion of size 15×8 cm was found superficial to external oblique aponeurosis [Table/Fig-2]. There was no communication found with round ligament or preperitoneal adipose tissue. Complete excision of the tumour was done [Table/Fig-3] and histopathology confirmed the diagnosis of lipoma. The postoperative course was uneventful. DISCUSSION Lipomas in the groin region can be associated with inguinal hernia or can arise de novo, the later been termed as true lipoma of the groin [1,2]. True lipomas are not continuous with preperitoneal or retroperitoneal adipose tissue. Lipomas commonly encountered during inguinal hernia surgeries are in close relation with spermatic cord or round ligament with or without presence of hernial sac [2]. According to Lilly MC and Arregui ME in females, lipoma of the round ligament was found to be in 36% of patients operated for inguinal hernia [3]. No such association was found in the present case report. Clinical diagnosis of inguinal hernia is established with signs of positive cough impulse, increase in size of swelling on doing DIVISH SAXENA 1 , SIDDHARTH PRAMOD DUBHASHI 2 Keywords: Groin swellings, Inguinal hernia, Lipoma of round ligament ABSTRACT Diagnosis of a soft tissue tumour in groin region is rather misleading owing to the fact of similarity in complaints of pain and swelling, especially in cases of irreducible groin hernias. Strategic selection of investigations and treatment option plays an enormous role in preoperative management of these patients. Authors present a case of a 36-year-old female with a previous history of two cesarean sections through Pfannenstiel incision with a soft tissue irreducible swelling in left inguinal region. Computed Tomography (CT) abdomen revealed a groin lipomatous lesion. Groin lipomas should be included in the differential diagnosis of irreducible groin swellings. A history of previous cesarean section in this patient prompted us to have a provisional diagnosis of incisional hernia. Meticulous planning of specific treatment strategy is essential for an effective outcome. [Table/Fig-1a and b]: Computed Tomography (CT) abdomen coronal and sagittal images showing low attenuated mass (solid arrows) superficial to external oblique aponeurosis (yellow blank arrow). [Table/Fig-2]: Intraoperative picture showing origin of lipoma above external oblique aponeurosis (yellow arrow) [Table/Fig-3]: Specimen of giant lipoma measuring 15×8 cm.