A case of endometriosis presenting as an inguinal hernia

Abstract

Endometriosis is a common clinical presentation for gynaecologists. Occasionally it can present to general surgeons as a swelling in the groin or abdominal wall. This condition should be included in the differential diagnosis in female patients. A 32-year-old woman with a 2-year history of a painful persistent lump in her right groin was referred to the general surgeons by her general practitioner. She was referred with a diagnosis of a suspected inguinal hernia. MRI excluded a hernia and exploration of the groin and subsequent histology confirmed the lesion to be an endometrial deposit.

Extrapelvic endometrioma presenting as acute incarcerated right inguinal hernia in a postpartum patient

“…Candiani et al 7 reported six cases of inguinal endometriosis where site of lesion was the round ligament. Rare cases of extrapelvic endometriosis involving the abdominal wall and presenting as masses have also been reported in women of reproductive age, particularly in women with prior caesarean or surgical scars 2 6 8 9…”

“…Husain et al reported endometriosis presenting as a long-standing inguinal hernia 2. There is a case report of Pfannenstiel incisional endometrioma in the literature presenting as acute incarcerated incisional hernia, the patient presented with a tender mass directly at the corner of the healed left Pfannenstiel incision 4 years and 8 months after her caesarean section with no history of endometriosis 4.…”

“…Endometriosis is a common gynaecological diagnosis in women of reproductive age, and affects about 5%–10% of women 1. It is defined as normal endometrial glands and stroma outside of the uterine cavity 2. One presentation of endometriosis is in the form of an endometrioma, which is actually an endometrial cyst containing thick, brown, tar-like fluid and is often referred to as a ‘chocolate cyst.’ These cysts and endometrial deposits can be found in extrapelvic areas and are often adherent to surrounding structures and surgical scars and are thus misdiagnosed as other types of masses including lipoma, incisional hernia and abscess until further exploration is done by general surgeons; to whom it may pose a diagnostic challenge, since it is not well recognised among general surgeons 3…”

A case report of a 25 kg extraovarian “chocolate cyst” attached by a peduncle to the uterine fundus

“…It is thought that endometriomas form from deposition of endometriotic deposits with subsequent invagination of the underlying ovarian cortex.Although majority of chocolate cysts arise from the ovaries, a significant proportion have been found in other sites including the peritoneum overlying the anterior and posterior cul de sac, within the broad ligament and inguinal canal as well as uterine serosa [6,7]. In addition, these cysts could be bilateral and are usually small to medium in size.…”

Inguinal endometriosis: a differential diagnosis of right groin swelling in women of reproductive age

“…A case of inguinal endometriosis collected from the canal of Nuck has reported, which presented as a reducible right groin swelling. Less than 50% of cases of inguinal endometriosis have been diagnosed preoperatively 5–7. It is a rare disease and a correct preoperative diagnosis might be challenging.…”