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Inguinal Hernia Containing Endometriosis
Jamele-Townley, L. OMSIII; Rivard, G, D.O.
Central Maine Medical Center, Lewiston, ME
Introduction: Endometriosis within the inguinal canal is exceedingly rare. Upon review of the
literature, only 82 cases of inguinal endometriosis have been recorded since 1896. Of those
82, only 30% have included inguinal hernias. Approximately 5-10% of the population will
experience a hernia throughout their lifetime. Inguinal hernias are the most frequent groin hernia
variant and, although they occur more often in men, women have a 5% lifetime risk of
developing one. Additionally, endometriosis is one of the most commonly encountered
gynecologic pathologies. Endometriosis consists of ectopic endometrial implants that are
usually discovered at extrauterine sites such as the ovaries, rectovaginal pouch, and pelvic
peritoneum. While the exact prevalence of endometriosis in the general population is unknown,
it is estimated to affect approximately 8-15% of premenopausal women. The following is a
unique case demonstrating the co-occurrence of two common pathologies.
Case: A 45 year old nulliparous Caucasian female presented for a surgical consult regarding a
right inguinal mass. The patient’s extensive review of systems included back pain during the
menstrual cycle.. The mass was first noticed by the patient 6 months prior to the consult. The
patient had experienced a year of groin discomfort as well as an intentional 15 pound weight
loss. The groin discomfort was best noticed when standing and was more difficult to appreciate
when lying supine. The mass provided more discomfort than pain. PCP obtained an ultrasound
revealing a 2.7 x 1.3 cm inhomogeneous echoic focus suggesting an attached fluid collection.
Physical examination during the consult was not explicitly suggestive of a hernia and raised
more concern for possible malignant lymphadenopathy. The patient was scheduled for
lymphadenectomy the following week. During the procedure, dissection was carried into the
external ring and a firm palpable lump was identified. This did not appear to be a lymph node,
as it was covered with a smooth membrane and contained within a hernia sac. The sac was
then traced up to the internal canal where a right incarcerated inguinal hernia was diagnosed.
The hernia sac and contents were sent to pathology for evaluation and ultimately revealed a
rubbery tan nodule measuring 2.5 cm x 1.2 cm x 2.0 cm that was covered by a smooth
mesothelial-lke lining and contained endometriosis.
Discussion: In the instance of a groin mass, it is important to obtain a detailed reproductive
history from the patient, as symptoms such as cyclical pelvic pain and/or infertility may lead the
provider to consider gynecologic involvement. This case illustrates that when a female of
reproductive age presents with a groin mass, the provider should include a detailed gynecologic
review of system with endometriosis included within a broad differential diagnosis.