Inguinal Endometriosis: Unusual Cause of Groin Pain

Fujikawa, Hirohisa; Uehara, Yuya

doi:10.4274/balkanmedj.galenos.2020.2020.2.105

Cited by 10 publications

(8 citation statements)

References 3 publications

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“…MRI is particularly useful in diagnosing lesions in the extraperitoneal area, and can also be used to identify sub-peritoneal endometriotic deposits [ 9 ]. MRI scans of IEM have distinct characteristics [ 2 ], including hyperintense T1-weighted images of hemorrhagic micro cysts that provide diagnostic clues for IEM [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Long term follow-up of inguinal endometriosis

Mu¹,

Zhang²,

Liu³

et al. 2021

BMC Women's Health

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Background Inguinal endometriosis (IEM) is a rare extra pelvic endometriosis. Here, we study the clinical characteristics, management strategies, and long-term gynecological outcomes of IEM patients at Beijing Chaoyang Hospital. Case presentation Three patients presented with a total of four lesions (one on the left side, one on the right side, and one bilaterally). The diameters of the four lesions were 2 cm, 2 cm, 3.5 cm and 1.5 cm, respectively. Two patients were admitted with inguinal hernias. Two patients were admitted with endometrioses—one with ovarian endometriosis and one with pelvic endometriosis. The hernia sac was repaired concomitantly via excision of the round ligament in two patients. One patient underwent a concomitant laparoscopy for gynecologic evaluations, including an ablation to the peritoneal endometriosis, and resection of the left uterosacral ligament endometriosis and pelvic adhesiolysis. All lesions were located on the extraperitoneal portion of the round ligament and were diagnosed histologically. No recurrence was observed in the inguinal region. All patients diagnosed with adenomyosis were treated with medication alone without any complaints. Conclusions Inguinal endometriosis can occur simultaneously with pelvic endometriosis. In most cases, a concomitant hernia sac appears together with groin endometriosis. Clinical management should be individualized and performed in tandem with general practitioners and obstetrics & gynecology experts. Pelvic disease, in particular, should be followed-up by a gynecologist.

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Section: Discussionmentioning

confidence: 99%

Long term follow-up of inguinal endometriosis

Mu¹,

Zhang²,

Liu³

et al. 2021

BMC Women's Health

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“…IEM is prone to misdiagnosis before surgery[ 11 , 13 ], possibly due to its uncommon location, the noncyclic pain pattern in a number of patients[ 14 - 16 ] or the inconclusive results from US[ 17 , 18 ]. Symptomatic patients often visit a surgeon rather than a gynecologist[ 3 , 6 , 10 , 19 ], so IEM is often misdiagnosed as a common groin disease such as IH[ 17 , 20 ]. More explicitly, IEM can be discovered in the extraperitoneal part of the round ligament, subcutaneous fat tissue, inguinal lymph nodes, and even in the sac wall of the inguinal or femoral hernia[ 6 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although catamenial symptoms should increase the index of suspicion for IEM[ 3 , 8 , 9 , 19 ], typical catamenial symptoms are present in only 50% of IEM cases. Due to the uncommon location of IEM lesions, symptomatic patients usually see a general surgeon rather than a gynecologist[ 3 , 6 , 15 , 17 , 19 , 20 ], and the diagnosis is frequently incidental or is made upon histologic examination.…”

Section: Discussionmentioning

confidence: 99%

“…In cesarean section surgery, it is beneficial to clean the operative field with a high-flow saline solution before closing the incision line[ 42 ]. Due to the possibility of pelvic EM, laparoscopic diagnosis or postoperative referral to a gynecologist should be performed at the same time, especially for infertile women[ 3 , 18 - 20 ]. Individualized clinical treatment should be provided in collaboration with general practitioners and obstetrics and gynecology specialists[ 43 ].…”

Section: Discussionmentioning

confidence: 99%

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Inguinal endometriosis: Ten case reports and review of literature

Li¹,

Sun²,

Li³

et al. 2021

WJCC

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BACKGROUND To describe the characteristics, diagnosis and surgical treatment of inguinal endometriosis (IEM). CASE SUMMARY We retrospectively analyzed 10 patients diagnosed with IEM at Beijing Chao-Yang Hospital from 2011 to 2019. Relevant features, symptoms, images, surgical treatment, hormonal therapy and follow-up were collected and discussed. A total of 10 cases of IEM diagnosed by surgery and pathology were characterized by a lesion on the right side (9/11); five patients had symptoms related to the menstrual cycle, and only 3 patients were clearly diagnosed before surgery. Ultrasonography was of little assistance in confirming the diagnosis, but magnetic resonance imaging showed specific, high-intensity patterns. Anatomically, most of the IEM lesions were located in the extraperitoneal ligament (10/11); nine patients had inguinal hernias (IH), five had concurrent or prior pelvic endometriosis, and four had infertility. The clinical results from extensive resection were satisfactory. CONCLUSION IEM is an extremely rare condition that can easily be misdiagnosed prior to surgery. A right IH may contribute to the formation of right-sided IEM, and extensive resection involving the round ligament and hernia sac is essential to prevent recurrence.

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“…The differential diagnosis of a groin lump or a subcutaneous mass of the inguinal region is challenging and may include a wide variety of entities such as hernia, lymph node enlargement, malignancy, endometriosis, Nuck hydrocele, lipomas, and abscess [ 42 ]. The presence of endometriosis in the inguinal canal is rare with an estimated prevalence of 0.3–0.6% of all endometriosis cases [ 37 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Endometriosis of the Canal of Nuck: A Systematic Review of the Literature

Prodromidou¹,

Pandraklakis²,

Rodolakis³

et al. 2020

Diagnostics

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Endometriosis is a common benign gynecological condition defined as the presence of endometrial tissue in tissues outside the uterine cavity. Apart from the common sites of endometriosis, rare sites other have also been reported including the liver, the thoracic cavity, the muscles, nerves, and more rarely in a patent Nuck canal. We aim to evaluate the clinical presentation, diagnostic features, and management of the Nuck endometriosis. A meticulous search of three electronic databases was performed until May 2020 for articles reporting cases of Nuck endometriosis. A total of 36 patients from 20 studies were analyzed. Median age of patients was 36 years with 33 women being of reproductive age. A right-sided lesion was identified in 30 cases (83.3%), while all patients suffer from a groin mass with cyclic pain in a proportion of 22%. All the patients finally underwent surgery for investigation of the lesion and fixation of the defect. Five cases of malignancy were detected at final pathology. All of them were alive with a median reported overall survival of 37 months. Nuck endometriosis should be included in the differential diagnosis of female patients with groin swelling. An evaluation by a gynecologist is important when endometriosis is suspected.

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Inguinal Endometriosis: Unusual Cause of Groin Pain

Cited by 10 publications

References 3 publications

Long term follow-up of inguinal endometriosis

Long term follow-up of inguinal endometriosis

Inguinal endometriosis: Ten case reports and review of literature

Endometriosis of the Canal of Nuck: A Systematic Review of the Literature

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