WTP6.11 More Than a Femoral Hernia: An Unusual Presentation of Endometriosis

Abstract Introduction Endometriosis is characterised by the presence of endometrial tissue outside the uterine cavity. It is often localised to the ovaries and fallopian tubes, and when a distinct mass forms, it is termed an endometrioma. Extra-pelvic involvement is uncommon and can be misdiagnosed as other pathologies. Endometriosis presenting as a femoral hernia is exceptionally rare, with only a few cases documented in the literature. We present a case of an endometrioma manifesting as a hernia in a patient with a known history of endometriosis. Methods A 41-year-old woman presented with a 4-year history of a right groin lump, which had recently become symptomatic with increasing pain and tenderness. Preoperative imaging, including MRI and ultrasound, revealed a 24 mm nodule at the medial right inguinal canal, suspected to be an endometrioma. The patient underwent surgical exploration of the right groin, including excision of the mass and hernia repair. Results Intraoperatively, a 2 x 2.5cm mass was found medial to the femoral vessels, at the expected site of a femoral hernia. The mass was successfully excised, and the hernia defect repaired. Histological examination revealed endometrial-type glands within a fibromuscular nodule, confirming the diagnosis of endometriosis. Conclusion This case highlights a unique aetiology of a presentation commonly encountered in general surgery: hernias. This report may serve as a learning point for differentials of groin masses in women of reproductive age. Excision of the endometrioma and hernia repair is an effective therapeutic approach, with histological confirmation crucial for definitive diagnosis.