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

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.