Mushiake Shu, Kawaguchi Nao, Asakuma Mitsuhiro, Komeda Koji, Shimizu Tetsunosuke, Hirokawa Fumitoshi, Shimomura Tomoo, Lee Sang-Woong
Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan.
Department of Surgery, Sousei Hospital, Kadoma, Osaka, Japan.
Surg Case Rep. 2023 Jan 26;9(1):12. doi: 10.1186/s40792-022-01571-x.
Inguinal endometriosis is a rare clinical disease with an unclear etiology and pathogenesis, and its diagnosis requires accurate medical history-taking and histological examination. However, surgical treatment for the condition has not yet been standardized. This report presents two cases of inguinal endometriosis.
The first patient was a 36-year-old woman who complained of pain and swelling in her right inguinal region. Physical examination revealed a soft, tender right inguinal mass. The size of the mass repeatedly increased and decreased during menstruation and did not show swelling with abdominal pressure. Magnetic resonance imaging showed a 3.5 × 2.5 cm mass with high intensity on T2-weighted imaging in the right inguinal canal, and no communication was found between the lesion site and the abdominal cavity. We diagnosed this case as inguinal endometriosis and managed it using an anterior approach and laparoscopic observation. The second patient was a 51-year-old woman who presented with an intermittently painful mass in her right inguinal region. The mass tended to increase in size, with worsening pain before menstruation. Abdominal computed tomography revealed a 2 × 2 cm cystic mass in the right inguinal region. We made a diagnosis of inguinal ectopic endometriosis and decided to operate via the totally extraperitoneal (TEP) method for excision plus transabdominal observation. The postoperative course in both cases was uneventful with no recurrence.
Inguinal endometriosis is a rare entity that should be suspected in patients with cyclical symptoms of inguinal pain and swelling that correlate with their menstrual cycle, which might otherwise be attributed to inguinal hernia. It is crucial to make a preoperative diagnosis based on a careful medical review, physical examination, and imaging studies, and to make an appropriate surgical plan. Particularly, in the case of ectopic inguinal endometriosis involving the canal of Nuck, laparoscopic observation is useful for the intraoperative diagnosis of inguinal endometriosis to help rule out the involvement of other abdominal sites. However, it is important to select and modify the surgical technique to avoid rupturing the endometrisis mass and prevent postoperative recurrence.
腹股沟子宫内膜异位症是一种临床罕见疾病，其病因和发病机制尚不明确，诊断需要准确的病史采集和组织学检查。然而，针对该疾病的手术治疗尚未标准化。本报告介绍两例腹股沟子宫内膜异位症病例。
首例患者为一名36岁女性，主诉右侧腹股沟区疼痛和肿胀。体格检查发现右侧腹股沟有一个柔软、压痛的肿块。肿块大小在月经期间反复增大和缩小，腹部加压时不出现肿胀。磁共振成像显示右侧腹股沟管内有一个3.5×2.5厘米的肿块，在T2加权成像上呈高信号，病变部位与腹腔之间未发现连通。我们将该病例诊断为腹股沟子宫内膜异位症，并采用前路和腹腔镜观察进行处理。第二例患者是一名51岁女性，表现为右侧腹股沟区间歇性疼痛性肿块。肿块有增大趋势，月经前疼痛加重。腹部计算机断层扫描显示右侧腹股沟区有一个2×2厘米的囊性肿块。我们诊断为腹股沟异位子宫内膜异位症，并决定通过完全腹膜外（TEP）方法进行手术切除并经腹观察。两例患者术后病程均顺利，无复发。
腹股沟子宫内膜异位症是一种罕见疾病，对于有与月经周期相关的腹股沟疼痛和肿胀周期性症状的患者应予以怀疑，否则这些症状可能归因于腹股沟疝。基于仔细的医学评估、体格检查和影像学检查进行术前诊断并制定合适的手术方案至关重要。特别是，对于累及Nuck管的异位腹股沟子宫内膜异位症病例，腹腔镜观察有助于术中诊断腹股沟子宫内膜异位症，以排除其他腹部部位受累情况。然而，选择和改进手术技术以避免子宫内膜异位肿块破裂并防止术后复发很重要。
