A peritoneal inclusion cyst is a very rare mesenteric cyst of mesothelial origin occurring in the peritoneal cavity, mostly affecting women in the reproductive age. Unilocular peritoneal inclusion cysts are usually asymptomatic, but occasionally present with various, nonspecific symptoms, which makes correct preoperative diagnosis difficult [
An 82-year-old white Caucasian female was admitted to our hospital suffering from a palpable groin mass on the right, which appeared two days ago, but for the last hours before admission it became painful and caused great discomfort. The mass was tender and tense on physical examination measuring at least 8 cm on diameter, and it was not reducible. The initial differential diagnosis was either a strangulated femoral or groin hernia. She had no history of other hernias and her laboratory findings were within normal range. Also no history of previous surgery, endometriosis, or pelvic inflammatory disease existed. An inguinal approach was selected and after opening the skin and subcutaneous fat the mass was found protruding through the femoral ring. Our initial thought was that it was a bulge of abdominal contents covered by peritoneum, but after careful dissection it turned out to be a large unilocular cyst, containing serous fluid, probably originating from the peritoneum. Frozen section was negative for malignancy and cyst excision was easily performed. McVay procedure was used to reapproximate the femoral ring. The patient’s postoperative course was uneventful, and she was discharged on the first postoperative day. The histologic examination of the cyst showed a fibrous wall of variable thickness with inflammatory and hemorrhagic infiltrations. Its inner surface was almost completely covered with hemorrhagic tissue and fibrin, lacking epithelial lining. Focally, the presence of a few mesothelial cells in a linear pattern was noted (Figure
Histological section of the cystic wall showing the presence of mesothelial cells (Hematoxylin-Eosix ×400).
Positive immunohistochemical stain for CK 5/6 confirming the presence of the above mesothelial cells (×400).
Peritoneal inclusion cysts are very rare and only about 900 cases are reported in the literature [
A femoral hernia usually presents as a tender, nonreducible swelling, situated below, and lateral to the pubic tubercle. The differential diagnoses include inguinal hernia, lipoma, saphena varix, enlarged lymph nodes, femoral artery aneurysm, sarcoma, obturator hernia, psoas abscess, psoas bursa, and in males, ectopic testis. Different contents in femoral hernias have been reported in the literature, such as appendix, small intestine, omentum, bladder, Meckel’s diverticulum, ectopic testis, adnexa, and stomach [
In conclusion, high index of clinical suspicion and careful exploration during repair of a femoral hernia is mandatory in order to reach the correct diagnosis about the contents of the hernia.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
The authors declare that they have no conflict of interests.