Clinical aspects and management of inguinal endometriosis: A case series of 20 patients

Abstract

Aim This study aimed to describe the clinical presentation, diagnostic evaluation, and operative or medical management of inguinal endometriosis. Methods In this study, we retrospectively reviewed 20 cases of inguinal endometriosis in our facility, particularly on the clinical characteristics, diagnosis, and surgical and medical treatment. Results We retrospectively investigated the following items for each patient: age at diagnosis, surgical history, presence of extragenital endometriosis, symptoms, imaging modalities, surgical therapy, hormonal therapy, follow‐up period, postoperative recurrence and time to recurrence. We identified 20 cases of inguinal endometriosis in our facility. First, 75% of the patients had right inguinal endometriosis. Second, T1‐weighted or fat‐saturated T1‐weighted images showed hyperintensity in the lesions in 17 patients (17/18 patients, 94.4%). Third, in 5 of 6 patients who underwent surgical therapy, we performed radical surgery to excise the inguinal lesion including the round ligament. One patient had disease relapse. Fourth, in 6 of 7 cases, dienogest effectively improved pain without significant adverse effects, but oral contraceptive was effective in 1 of 4 patients without significant adverse effects. Conclusion We retrospectively reviewed 20 patients with inguinal endometriosis in our facility. We have shown that magnetic resonance imaging can be a useful imaging modality to obtain a specific diagnosis of this disease. In addition, inguinal endometriosis can be managed with radical surgery to resect lesions including the round ligament and with hormonal treatment. In particular, dienogest ameliorated symptoms, which can be an option for patients who do not want surgery.

Extra‐pelvic endometriosis: A review

“…The average age at diagnosis is approximately 37 years old. 10,56,57 Inguinal endometriosis predominantly develops in the right groin, [56][57][58][59][60][61] and the mechanism is often explained mainly by the theory of reflux of menstrual blood into the pelvis. [62][63][64] The abdominal fluid containing the endometrium circulates clockwise in the abdominal cavity, and the sigmoid colon blocks the abdominal fluid from entering the left inguinal ring (Figure 1).…”

“…62,63 Inguinal endometriosis occurs in several different forms, including cystic lesions in the hernia sac and Nuck's canal, and solid mass lesions in the extra-pelvic round ligaments and subcutaneous tissue ( Figure 2). 57,65 MRI is especially useful for preoperative diagnosis of inguinal endometriosis. 57,65 MRI typically shows two types of inguinal endometriosis on T1-weighted images, one characterized by hyperintense hemorrhagic cysts and another by a hypointense solid mass with hyperintense hemorrhagic cysts.…”

“…57,65 MRI is especially useful for preoperative diagnosis of inguinal endometriosis. 57,65 MRI typically shows two types of inguinal endometriosis on T1-weighted images, one characterized by hyperintense hemorrhagic cysts and another by a hypointense solid mass with hyperintense hemorrhagic cysts. 65 In our case series, in 17 of 18 patients who underwent MRI, hyperintensities were seen in T1-weighted images or fat-saturated T1-weighted images.…”

“…65 In our case series, in 17 of 18 patients who underwent MRI, hyperintensities were seen in T1-weighted images or fat-saturated T1-weighted images. 57 In particular, fat-saturated T1-weighted images were helpful for the diagnosis of inguinal endometriosis. In particular, it is difficult to diagnose endometriosis associated with Nuck's canal hydrocele before surgery, but preoperative diagnosis can be improved by identifying hyperintense sites within the lesion on T1-weighted and fat-saturated T1-weighted images.…”

“…In particular, it is difficult to diagnose endometriosis associated with Nuck's canal hydrocele before surgery, but preoperative diagnosis can be improved by identifying hyperintense sites within the lesion on T1-weighted and fat-saturated T1-weighted images. 57 Regarding treatment, most reports have described cases with surgical treatment, and reports on cases receiving hormonal therapy alone are very limited. As a radical surgical treatment, an en bloc resection of tumor and the round ligament has been reported.…”