Surgical Management of Inguinal Endometriosis

Abstract

Study Objective To demonstrate surgical management of an inguinal endometrioma. Design Stepwise demonstration of surgical techniques with narrated video footage. Setting Yale New Haven Hospital, New Haven, CT. Patients or Participants A 31-year-old woman with a painful right inguinal endometrioma. Interventions The patient underwent diagnostic examination with pelvic MRI, which noted concern for an inguinal endometrioma. Biopsy confirmed endometriosis. She then underwent diagnostic laparoscopy, with resection of intra-pelvic and inguinal endometriosis. The technical steps of management and resection of an inguinal endometrioma have been detailed in the video with an emphasis on anatomic landmarks by utilizing visual illustrations. An incision was made at the inguinal ligament and taken down to the superficial fascia using Bovie cautery. The mass was progressively mobilized from the superficial inguinal ring superiorly, sartorius muscle laterally, and adductor longus muscle medially. Several perforating branches of the femoral vein as well as the round ligament of the uterus, at the level of the external inguinal ring, were ligated and tied off. The mass was removed in full, and the resected bed fulgurated. A drain was placed and the incision was closed in multiple layers. Measurements and Main Results Diagnostic laparoscopy revealed intrapelvic Stage I endometriosis. The right round ligament and internal inguinal ring were without evidence of endometriosis. The 3.1 × 3 × 2.8 cm inguinal mass was fully resected. Final pathology confirmed both intrapelvic and inguinal endometriosis. Conclusion Inguinal endometriosis is exceedingly rare, with an estimated incidence of 0.6%. Given the broad differential diagnosis, imaging should be performed. In addition, biopsy can be considered, provided a hernia has been ruled out. Surgical management should entail diagnostic laparoscopy and excisional surgery. To demonstrate surgical management of an inguinal endometrioma. Stepwise demonstration of surgical techniques with narrated video footage. Yale New Haven Hospital, New Haven, CT. A 31-year-old woman with a painful right inguinal endometrioma. The patient underwent diagnostic examination with pelvic MRI, which noted concern for an inguinal endometrioma. Biopsy confirmed endometriosis. She then underwent diagnostic laparoscopy, with resection of intra-pelvic and inguinal endometriosis. The technical steps of management and resection of an inguinal endometrioma have been detailed in the video with an emphasis on anatomic landmarks by utilizing visual illustrations. An incision was made at the inguinal ligament and taken down to the superficial fascia using Bovie cautery. The mass was progressively mobilized from the superficial inguinal ring superiorly, sartorius muscle laterally, and adductor longus muscle medially. Several perforating branches of the femoral vein as well as the round ligament of the uterus, at the level of the external inguinal ring, were ligated and tied off. The mass was removed in full, and the resected bed fulgurated. A drain was placed and the incision was closed in multiple layers. Diagnostic laparoscopy revealed intrapelvic Stage I endometriosis. The right round ligament and internal inguinal ring were without evidence of endometriosis. The 3.1 × 3 × 2.8 cm inguinal mass was fully resected. Final pathology confirmed both intrapelvic and inguinal endometriosis. Inguinal endometriosis is exceedingly rare, with an estimated incidence of 0.6%. Given the broad differential diagnosis, imaging should be performed. In addition, biopsy can be considered, provided a hernia has been ruled out. Surgical management should entail diagnostic laparoscopy and excisional surgery.