Falsa hernia inguinal por endometriosis en el ligamento redondo

Marcos Bruna, Gonzalo Martı́n, David Dávila, José Miguel Rayón, José V. Roig
In: Progresos de Obstetricia y Ginecología · 2010 · vol. 53(8) , pp. 320–323 · doi:10.1016/j.pog.2009.12.011 · W1964450073
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This case report details a 43-year-old woman with an inguinal tumor caused by endometriosis of the round ligament, treated successfully with complete surgical excision.

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Abstract

La localización extraperitoneal de la endometriosis es muy infrecuente; el ligamento redondo es una zona de posible asentamiento, lo que condiciona la aparición de una tumoración inguinal en ciertas ocasiones. Presentamos el caso de una paciente de 43 años que consulta por tumoración inguinal derecha de 2 años de evolución con aumento progresivo de su tamaño y molestias locales. A la exploración, se aprecia una tumoración dolorosa que protruye por el orificio inguinal externo. Se la interviene por vía preperitoneal y se evidencia una tumoración adherida al ligamento redondo sin orificios herniarios, por lo que se practica una exéresis amplia y completa de la lesión. El informe histopatológico indicó la presencia de tejido altamente sugestivo de endometriosis del ligamento redondo. Las formas extraperitoneales de endometriosis son infrecuentes y, entre ellas, las de la pared abdominal suelen localizarse en cicatrices laparotómicas y perineales tras intervenciones quirúrgicas. Pueden presentar dispareunia, irregularidades menstruales, dismenorrea e infertilidad o, en ciertos casos, la clínica puede pasar inadvertida. La exéresis completa es la estrategia más apropiada en la enfermedad inguinal localizada; es importante el estudio de exclusión de la endometriosis pélvica intraperitoneal, ya que la asociación de ambas entidades alcanza un 25%. An extraperitoneal endometriosis is a rare condition, with the round ligament being a possible location, sometimes leading to inguinal tumours. A 43 year-old women, who was seen due to having a tumour in right groin of 2 years progression gradually increasing in size and with local discomfort. On examination a painful tumour was found which protruded from the external inguinal orifice. She was intervened using a preperitoneal approach, showing evidence of tumour adhered to the round ligament with no hernial orifices. An extensive and complete exeresis was performed. The histopathology report indicated the presence of tissue highly suggestive of an endometriosis of the round ligament. Extra-peritoneal forms of endometriosis are uncommon, and among them, they are usually located in the abdominal wall in laparotomy and perineal scars after surgical interventions. They can present as dyspareunia, irregular periods, dysmenorrhea and infertility, or in some cases, the clinical picture may pass unnoticed. Complete removal is the most appropriate strategy in localised inguinal disease, with the study to exclude intraperitoneal pelvic endometriosis being important, since both conditions reach percentages of 25%.

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Condition tags

endometriosisdysmenorrheadyspareuniainfertility

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