General surgeon’s experience in managing extra pelvic endometriosis

Muhammad Eimaduddin Sapiee, Roziana Ramli, Nor Syahaniza Waheeda Alias, Mohamed Afiq Hidayat Zailani
In: International Surgery Journal · 2020 · vol. 7(7) , pp. 2384 · doi:10.18203/2349-2902.isj20202853 · W3037702022
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This paper reports two cases of extrapelvic endometriosis presenting as abdominal wall and inguinal masses, which were successfully managed by general surgeons through excision.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

This paper reports two unusual cases of extra-pelvic endometriosis encountered by general surgeons: a cyclical painful abdominal wall mass in the left iliac fossa with imaging and fine-needle aspiration supporting endometriosis, and a painless inguinal-area swelling during pregnancy explored as a left inguinal hernia but found as an encysted inguinal canal mass with histopathology confirming endometriosis. Surgical excision was performed in both cases, and follow-up with gynecology is described. The authors’ key point is that endometriosis should be included in the differential diagnosis for female patients presenting with abdominal wall masses or inguinal swelling. This paper is centrally about endometriosis — specifically extra-pelvic (abdominal wall and inguinal) endometriosis managed by general surgeons.

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Abstract

Two unusual cases of extrapelvic endometriosis are discussed here. Both presented themselves to the general surgeons. Case 1 presented with cyclical painful abdominal wall mass at the left iliac fossa region. Ultrasound and computed tomography scan showed a solitary mass at the subcutaneous region and fine needle aspiration cytology revealed endometriosis. The patient underwent wide surgical excision and recovered. Case 2 presented with painless swelling at the left inguinal area whilst being pregnant. Surgical exploration was performed for ‘left inguinal hernia’ but an encysted mass was found in the inguinal canal which was excised. Histopathological examination reported endometriosis. Both cases were subsequently under gynaecological follow-up. It is important for the surgeons to include endometriosis as one of the differential diagnosis in the management of their female patients with mass or swelling.
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General surgeon’s experience in managing extra pelvic endometriosis DOI: https://doi.org/10.18203/2349-2902.isj20202853Keywords: Extra pelvic endometriosis, Abdominal wall mass, Inguinal swellingAbstract Two unusual cases of extrapelvic endometriosis are discussed here. Both presented themselves to the general surgeons. Case 1 presented with cyclical painful abdominal wall mass at the left iliac fossa region. Ultrasound and computed tomography scan showed a solitary mass at the subcutaneous region and fine needle aspiration cytology revealed endometriosis. The patient underwent wide surgical excision and recovered. Case 2 presented with painless swelling at the left inguinal area whilst being pregnant. Surgical exploration was performed for ‘left inguinal hernia’ but an encysted mass was found in the inguinal canal which was excised. Histopathological examination reported endometriosis. Both cases were subsequently under gynaecological follow-up. It is important for the surgeons to include endometriosis as one of the differential diagnosis in the management of their female patients with mass or swelling. Metrics References Markham SM, Carpenter SE, Rock JA. Extra pelvic endometriosis. Obstet Gynecol Clin North Am. 1989;16:193-219. Oh EM, Lee WS, Kang JM, Choi ST, Kim KK, Lee WK. A surgeon’s perspective of abdominal wall endometriosis at a caesarean section incision: nine cases in a single institution. Surg Res Pract. 2014; 2014:765372. Narmeen T, Pervez M. Scar Endometriosis: Experience of a Surgeon. Medicine Today. 2019;31(1):42-5. Celik GH, Karacan T, Kaya. Abdominal wall endometriosis: A monocentric continuous series and review of the literature. J Endometriosis Pelvic Pain Disorders. 2019;11(2):95-101. Wolf Y, Haddad R, Werbin N, Skornick Y, Kaplan O. Endometriosis in abdominal scars: a diagnostic pitfall. Am Surg. 1996;62:1042-4. Husain F, Siddiqui ZA, Siddiqui. A case of endometriosis presenting as an inguinal hernia. BMJ Case Rep. 2015;2105. Singh KK, Lessells AM, Adam DJ, Jordan C, Miles WF, Macintyre IM, et al. Presentation of endometriosis to general surgeons: a 10 years’ experience. Br J Surg. 1995;82:1349-51. Zhang J, Liu X. Clinicopathological features of endometriosis in the abdominal wall clinical analysis of 151 cases. Clin Exp Obstet Gynecol. 2016;43:379-83. Albutt KC, Odom GS, Gupta A. Endometriosis within a left-sided inguinal hernia sac. J Surg Case Reports. 2014;5(10)1093. Candiani BG, Vercellini P, Fedele L, Vendola N, Carinelli S, Scaglione V. Inguinal endometriosis: pathogenetic and clinical implications. Obstetr Gynecol. 1991;78(2)191-4. Wong WS, Lim CE, Luo X. Inguinal endometriosis: an uncommon differential diagnosis as an inguinal tumour. ISRN Obstet Gynecol. 2011;2011:2712159. Hoffbeck AD, Meyer HC. Endometriosis of the round ligament revealed by an intermittent hernia. Gynecol Surg. 2006;3:295-7. Medeiros FDC, Cavalcante DIM, Medeiros SMA, Eleuterio JJ. Fine-needle aspiration cytology of scar endometriosis: study of seven cases and literature review. Diagnos Cytopathol. 2011;39:18-21. Leite GKC, Carvalho LFPD, Korkes H, Guazzelli TF, Kenj G, Viana ADT. Scar endometrioma following obstetric surgical incisions: a retrospective study on 33 cases and review of the literature. Sao Paulo Med J. 2009;127(5):270-7. Kirkpatrick A, Reed CM, Mansfield BLT. Radiologic-pathologic conference of Brooke Army Medical Center: endometriosis of the canal of Nuck. Am J Roentgenol. 2006;186:56-7. Kocakusak A, Arpinar E, Arikan S, Demirbag N, Tarlaci A, Kabaca C. Abdominal wall endometriosis: a diagnostic dilemma for surgeons. Medical Principles and Practice. 2005;14(6):434-7. Wasfie T, Gomez E, Seon S, Zado B. Abdominal wall endometrioma after cesarean section: a preventable complication. Int Surg. 2002;87(3):175-7. Picod G, Boulanger L, Bounoua F, Leduc F, Duval G. Abdominal wall endometriosis after caesarean section: report of fifteen cases. Gynecol Obstet Fertil. 2006;34:8-13.

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