Inguinal endometriosis, a rare entity of which surgeons should be aware: clinical aspects and long-term follow-up of nine cases
Inguinal endometriosis is a rare disease and often misdiagnosed for other, more common groin pathology. We present nine cases of women with inguinal endometriosis with long-term follow-up.
In this retrospective case series, the Dutch PALGA system was searched for all patients diagnosed with extrapelvic endometriosis located in the groin in the OLVG hospital, Amsterdam, between 2000 and 2016. Relevant information regarding pre- and postoperative characteristics and symptoms was collected. Follow-up consisted of a telephone call from the attending surgeon.
None of the patients had a history of pelvic endometriosis. Typically, they presented with a right-sided swelling in the groin. Preoperative ultrasound and MRI were in most cases inconclusive. In one of two patients fna indicated endometriosis. In only three patients the surgeon considered the diagnosis endometriosis preoperatively. Surgical removal was effective with no reported complications. A coexisting hernia sac was resected in four cases, and there was a suspicion of a persistent processus vaginalis (canal of Nuck) in three, suggesting that a persistent processus vaginalis is possibly an important key to the pathogenesis. In none of the cases there was an indication for mesh implantation. One patient was later diagnosed with pelvic endometriosis.
Follow-up by a gynecologist is advised to check for intra-abdominal disease and inform patients on fertility perspective. Surgeons should be aware of the possibility of inguinal endometriosis in fertile women with a lump in the groin.
KeywordsInguinal hernia Endometriosis Groin Processus vaginalis
Compliance with ethical standards
Conflict of interest
NW declares no conflict of interest. NS declares no conflict of interest. KDJ declares no conflict of interest. PVK declares no conflict of interest. MS declares no conflict of interest.
This article did not require ethical approval according to Dutch Law.
Human and animal rights
Human and/or animal rights were not violated.
Patients were contacted by phone by the surgical team that had performed the operation. If contacted and included, informed consent was given by the participants during the phone call.
- 8.Prabhu R, Krishna S, Shenoy R, Thangavelu S (2013) Endometriosis of extra-pelvic round ligament, a diagnostic dilemma for physicians. BMJ Case Rep. https://doi.org/10.1136/bcr-2013-200465
- 9.Breen JL, Neubecker RD. Tumors of the round ligament a review of the literature and a report of 25 cases. Obstet Gynecol. 1962;19(6)Google Scholar
- 13.Casparie M, Tiebosch a TMG, Burger G et al (2007) Pathology databanking and biobanking in The Netherlands, a central role for PALGA, the nationwide histopathology and cytopathology data network and archive. Cell Oncol 29(1):19–24. https://doi.org/10.1155/2007/971816 PubMedPubMedCentralGoogle Scholar
- 18.Mashfiqul MAS, Chintana CW, Tan YM (2007) Endometriosis of the inguinal canal mimicking a hernia. Singap Med J 48(6):e157–e159Google Scholar
- 24.Manatakis DK, Stamos N, Agalianos C, Vamvakas P, Kordelas A, Davides D (2013) Mesothelial cyst of the round ligament misdiagnosed as irreducible inguinal hernia. Case Rep Surg 2013(Fig. 2):2–5Google Scholar