Nodular adenomyosis of the uterus causing severe groin pain.

Tabrizi NM, Nasrin Moghadami Tabrizi, Babak Dabirashrafi, Dabirashrafi B, Parisa Salehi, Salehi P, Shahram Shams, Shams S, Dabirashrafi H, H Dabirashrafi, Hormoz Dabirashrafi
JSLS : Journal of the Society of Laparoendoscopic Surgeons · 2006 · vol. 10(1) , pp. 74–5 · PMID:16709363 · PMC3015687 · W186703357
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This case report describes two patients with nodular adenomyosis of the uterus near the round ligament causing severe groin pain, which was resolved by surgical excision.

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⚙ AI-generated deep summary by qwen3.7-flash, 2026-08-21 · read from full text ⓘ

This case report describes two young women presenting with severe, cyclic groin pain initially misdiagnosed as inguinal hernias or endometriosis of the round ligament. Diagnostic laparoscopy revealed small, myoma-like masses located on the uterus near the right round ligament insertion, which were surgically resected and confirmed via pathology to be nodular adenomyosis. Both patients experienced complete resolution of symptoms following the removal of these lesions, highlighting a rare presentation of uterine adenomyosis causing referred pain. This paper is centrally about adenomyosis — specifically describing nodular adenomyosis mimicking myomas near the round ligament insertion as a cause of severe groin pain.

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Abstract

OBJECTIVES: To determine the cause of severe, disabling, groin pain. METHODS: We describe in this case report 2 patients with severe groin pain. Two myoma-like masses were found on the uterus near the right round ligament. Both masses were excised via laparoscopy. RESULTS: The pathology report of these 2 cases indicated adenomyosis. Both patients were asymptomatic after the procedure. Adenomyosis usually propagates in the myometrium, and the nodular shape of this pathology is rare. In patients with severe groin pain (menstrual or continuous), the gynecologist should think about both endometriosis of the round ligament and adenomyosis near the round ligament. CONCLUSION: Severe groin pain is rare but disabling. Endometriosis of the external part of the round ligament is described as a cause. In this case report, we explain that nodular adenomyosis can also be a cause.
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Case

A 28-year-old G2, Lch2, female was admitted with severe groin pain and a history of taking daily intramuscular analgesics and a normal previous laparoscopy. Having the history of the previous patient (Case 1) in mind, we suggested a second-look laparoscopy. During the laparoscopy, we found that the uterus was asymmetrical, and a small bulge was seen near the right round ligament. The bulge was resected and found to be an infiltrated mass (16x15 mm) penetrating into the myometrium. Again, a cavity with dark blood was found in the center of this mass. The pathology report revealed adenomyosis of the uterus.The patient was totally asymptomatic after this procedure.

Conclusions

Endometriosis of the round ligament can cause severe groin pain. 5 , 6 Usually, it is located in the inguinal part of the round ligament. 1 , 2 Differentiation should be made between endometriosis of the round ligament and an inguinal hernia. 2 It is reported that this type of endometriosis occurs mostly on the right side. 5 What is interesting about our cases is that the location of the pathology was on the uterus near the insertion of the round ligament, on the right side in both cases. To our surprise, although the masses looked like myoma, the pathology report indicated adenomyosis.

Introduction

Endometriosis of the round ligament as a cause of groin pain has been reported previously. 1 – 4 In these reported cases, the primary diagnosis was thought to be irreducible hernia. In this article, we describe 2 patients with a myoma-like mass near the right round ligament that caused severe groin pain.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Endometriosis Pain Uterine Diseases Adult Endometriosis Female Groin Humans Pain Uterine Diseases

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References (6)

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