A Case of Pathologically Confirmed Inguinal Endometriosis Involving the Round Ligament: A Suggestion for the Standard Operative Approach

Tsuyoshi Kondo, S Matsuno, Hiroyoshi Ota, Tadasu Shionoiri, Yuriko Yokoi, I Shiozawa, Yuko Kobayashi
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2012 · vol. 28(2) , pp. 567–571 · doi:10.5180/jsgoe.28.567 · W2323120523
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⚙ AI-generated summary by claude@2026-06, 2026-06-14 ⓘ

This case report describes the successful laparoscopic and open surgical treatment of inguinal endometriosis involving the round ligament, recommending radical excision for recurrence prevention.

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This 2012 case report describes a 39-year-old woman with pathologically confirmed inguinal endometriosis involving the round ligament, presenting with right inguinal catamenial swelling starting at age 36 and catamenial pain beginning at age 39, without dysmenorrhea and with CT not showing a groin hernia. After diagnostic laparoscopic surgery confirming mild endometriosis, the authors performed a laparotomy with en-bloc excision of the pubic tubercle portion of the severed round ligament, and pathology was stump-negative on one side but positive on the other. They emphasize that because inguinal endometriosis is rare (<1% of cases), no standard operative procedure can be firmly established, but they suggest a radical excision extending the resection to the lateral inguinal fossa to reduce recurrence and advise intraoperative confirmation of the hernia gate. This paper is centrally about endometriosis—specifically inguinal endometriosis involving the round ligament and proposed surgical approach.

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Abstract

Inguinal endometriosis is a rare form of the condition; it accounts for less than 1% of the cases. Surgery is the primary treatment; however, it cannot be established as the procedure of choice because of the rarity of the disease and the fact that excision includes the round ligament. This case report deals with the treatment of inguinal endometriosis. The patient is a 39 year-old married woman with no history of pregnancy. She did not suffer from dysmenorrhea; however, she experienced right inguinal catamenial swelling beginning at 36 years of age. She experienced catamenial pain beginning at age 39 years. Inguinal pain was severe as measured by the Verbal Rating Scale. A groin hernia was not noted on computerized tomography (CT) . Right inguinal endometriosis was diagnosed and the patient underwent laparoscopic surgery, which confirmed mild endometriosis. The right inguinal region was laparotomically dissected. The round ligament was severed at the position of the internal oblique muscle. This point was selected because its extension to the lateral inguinal fossa appeared uninvolved. The pubic tubercle portion of the ligament was excised en-bloc and extracted. The pathological examination found that the pubic tubercle portion was stump-negative; however, the other side was positive. A groin hernia has been reported to be concurrent with 1/3 of the cases of inguinal endometriosis. A confirmation of the presence of a groin hernia is necessary before operation. For the prevention of recurrence, a radical excision with an extended resection to extract the round ligament up to the lateral inguinal fossa is necessary. Furthermore a confirmation of the hernia gate from the abdominal cavity should be made. Laparoscopy may become the procedure of choice for an abdominal approach. This report is significant in that it may result in the prevention of the need for repeat surgical procedures.
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Case report A Case of Pathologically Confirmed Inguinal Endometriosis Involving the Round Ligament: A Suggestion for the Standard Operative Approach 2012 Volume 28 Issue 2 Pages 567-571 Details Abstract Inguinal endometriosis is a rare form of the condition; it accounts for less than 1% of the cases. Surgery is the primary treatment; however, it cannot be established as the procedure of choice because of the rarity of the disease and the fact that excision includes the round ligament. This case report deals with the treatment of inguinal endometriosis. The patient is a 39 year-old married woman with no history of pregnancy. She did not suffer from dysmenorrhea; however, she experienced right inguinal catamenial swelling beginning at 36 years of age. She experienced catamenial pain beginning at age 39 years. Inguinal pain was severe as measured by the Verbal Rating Scale. A groin hernia was not noted on computerized tomography (CT) . Right inguinal endometriosis was diagnosed and the patient underwent laparoscopic surgery, which confirmed mild endometriosis. The right inguinal region was laparotomically dissected. The round ligament was severed at the position of the internal oblique muscle. This point was selected because its extension to the lateral inguinal fossa appeared uninvolved. The pubic tubercle portion of the ligament was excised en-bloc and extracted. The pathological examination found that the pubic tubercle portion was stump-negative; however, the other side was positive. A groin hernia has been reported to be concurrent with 1/3 of the cases of inguinal endometriosis. A confirmation of the presence of a groin hernia is necessary before operation. For the prevention of recurrence, a radical excision with an extended resection to extract the round ligament up to the lateral inguinal fossa is necessary. Furthermore a confirmation of the hernia gate from the abdominal cavity should be made. Laparoscopy may become the procedure of choice for an abdominal approach. This report is significant in that it may result in the prevention of the need for repeat surgical procedures. © 2012 Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy Favorites & Alerts Recently viewed articles

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