Clinical Characteristics and Surgical Treatment for Inguinal Endometriosis in Young Women of Reproductive Age

Abstract

Aim: To study the characteristics and surgical treatment of inguinal endometriosis (IEM), which can occur in women of reproductive age. Methods: Patients who underwent groin surgery at the Hiroshima City Funairi Citizens Hospital between 2004 and 2017 were retrospectively examined. Patients with IEM were divided into 3 groups based on the site of occurrence as follows: at a hernia sac or hydrocele of Nuck’s canal (type I), round ligament (type II), or subcutaneous area (type III). Clinical characteristics were compared among groups. Results: Of 2,798 patients investigated, 28 were pathologically diagnosed as having IEM with 15, 10, and 3 classified as type I, II, and III respectively. All patients presented with a mass (median 20 mm) and/or bulge that mainly occurred at the right inguinal region. Sixteen patients presented with inguinal pain associated with menstruation. While the groups did not differ in terms of most clinical characteristics, the lack of a preoperative diagnosis of IEM occurred more frequently for type I than for types II and III. Conclusions: Because IEM-type I might be underdiagnosed preoperatively, complete resection of a hernia sac or hydrocele of Nuck’s canal with subsequent pathological examination is required for women of reproductive age with an inguinal disease.

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

“…In this case, it recurred as a subcutaneous mass at the distal side of the round ligament. In a previous report, inguinal endometriosis recurred as a subcutaneous mass at the distal side of the circular ligaments in two patients, 8 and it closely resembles our case. Although they pointed out the possibility of transplantation at the first operation, there is also the possibility that a small lesion was left in the subcutaneous area on the distal side of the round ligament and the resected lesion.…”

“…In a previous report, inguinal endometriosis recurred as a subcutaneous mass at the distal side of the circular ligaments in two patients, and it closely resembles our case. Although they pointed out the possibility of transplantation at the first operation, there is also the possibility that a small lesion was left in the subcutaneous area on the distal side of the round ligament and the resected lesion . In this mechanism of recurrence, endometriosis may recur undeniably even after resection of the round ligament which is presumed to be the route of translocation.…”

“…In our cases, except for one patient who underwent emergency surgery in the diagnosis of incarcerated inguinal mass (Case 3), five patients were preoperatively diagnosed of inguinal endometriosis (83.3%, 5/6 cases). In addition, Nuck's canal hydrocele and inguinal hernia were found in 10 and 5 cases of the 28 cases, and in 2 and 2 cases of the 9 cases, respectively. Of the six patients who underwent surgery, three had Nuck's canal hydrocele and one had inguinal hernia in our study.…”

“…Although they pointed out the possibility of transplantation at the first operation, there is also the possibility that a small lesion was left in the subcutaneous area on the distal side of the round ligament and the resected lesion. 8 In this mechanism of recurrence, endometriosis may recur undeniably even after resection of the round ligament which is presumed to be the route of translocation. Furthermore, there have been few cases of recurrence and the risk factor is unknown; thus, further cases are required to be accumulated in the future.…”

“…It has been previously reported that preoperative diagnosis of inguinal endometriosis is low for cases with Nuck's canal hydrocele or inguinal hernia. 8 Therefore, surgeons and gynecologists should be aware that cases inguinal endometriosis may occur in those patients.…”