A case report of Inguinal Endometriosis-A rare entity of a common condition

A case report of Inguinal Endometriosis-A rare entity of a common condition | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A case report of Inguinal Endometriosis-A rare entity of a common condition Nilan Rodrigo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4050569/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: This case report discusses the presentation, diagnostic challenges, and successful surgical management of inguinal endometriosis(IEM). Case presentation: A 46-year-old Sinhalese woman experienced a painful lump in the right groin area for 5 years, with exacerbation during menstruation, coughing, and sneezing. Initial treatment, with depot methylprednisolone acetate injection, was ineffective. Two years later, at a different hospital, an endometriotic mass was identified in the right inguinal region, excision was not performed because of the propensity for vascular injury instead three doses of depot medroxyprogesterone acetate(DMPA) significantly alleviated the pain. When she presented to our hospital, a provisional diagnosis of right inguinal endometriosis was made after an ultrasound examination. A multidisciplinary approach involving a surgeon was employed for excision surgery, with meticulous attention given to avoiding femoral vein injury. The 45x25x25 mm mass, located in the inguinal ligament, was successfully removed. Conclusion : This case underscores the importance of collaboration between specialties for accurate diagnosis and effective surgical management of inguinal endometriosis. Preoperative imaging is useful, but the final diagnosis can be confirmed only after surgical excision and histopathology Obstetrics & Gynecology extrapelvic inguinal endometriosis round ligament surgical excision Figures Figure 1 Figure 2 Introduction Inguinal endometriosis was first described by Blanco et al. in 1986(1). Inguinal endometriosis is a very rare condition in which fewer than 150 cases have been reported in the literature as of 2020, (2), often presenting diagnostic challenges (3). This case report details the clinical course of a 46-year-old woman with a painful inguinal lump, highlighting the importance of accurate diagnosis and multidisciplinary collaboration in managing this condition. Case Presentation A 46-year-old woman, who underwent a caesarean section 15 years prior presented to our hospital gynaecology clinic with a painful lump in her right groin for 5 years, aggravated during menstruation and exacerbated by coughing and sneezing. She sought treatment at two teaching hospitals 3 years apart. In the first hospital, she received a depot methylprednisolone acetate injection, to which she did not respond. Two years later, she was taken to another teaching hospital for the excision of an endometriotic mass in her right inguinal area. Ultrasound revealed that the right femoral vein was 11 mm lateral to the lesion. However, excision was not performed because of the propensity for vascular injury. Instead, three doses of depot medroxyprogesterone acetate (DMPA) were administered at monthly intervals. The pain significantly improved with DMPA but she preferred surgical excision due to side effects of DMPA. On examination, there was a 3x3 cm tender subcutaneous mass in the right inguinal region 2 cm below the prior low suprapubic transverse incision. Diagnostic Workup: Ultrasound performed at our hospital revealed a 26 mm x 14 mm x 24 mm hypoechoic lesion within the rectus muscle, situated 7 mm away from the femoral vein. The lesion breached the posterior wall of the rectus abdominis muscle without intraperitoneal extensions. Medially, the lesion was 5 mm away from the pubic bone. The pelvic organs appeared normal. A provisional diagnosis of right inguinal endometriosis was made, and surgical excision was planned in consultation with a surgeon. Surgical Intervention: A 7 cm transverse incision, parallel to the existing previous caesarean scar, was made in the right groin. The 45x25x25 mm mass, with irregular black and blue regions, was located superior to the aponeurosis of the external oblique muscle, linked medially to the pubic tubercle, and laterally to the round ligament. Meticulous dissection, including excision of a portion of the round ligament and normal fat tissue, was performed ( figure1). Continuous vigilance was exercised to avoid potential femoral vein injury. The deep inguinal ring was closed. Outcome: Histopathology confirmed that the fibromuscular tissue contained endometrial glands and stroma (figure 2) Discussion The aetiology of inguinal endometriosis is uncertain. Several theories have been suggested, including the implantation theory, metaplasia within the round ligament, and retrograde menstruation (4). Niitsu et al (5) divided IEM into three types based on the location of the endometrial tissue: type I is a hernial sac or hydrocele in the Nuck canal, type II is in the round ligament, and type III is under the skin. IEM more commonly occurs on the right side, and the most prevalent is type II (6). This patient had type II disease according to Nitsu et al. (5), which supports the theory of metaplasia since endometriosis is confined to the round ligament (4). It is challenging to diagnose IEMs and IEMs are often prone to misdiagnosis, particularly because of the rarity of the condition and inconclusive ultrasound reporting (3, 7). Catamenial symptoms such as increased size, tenderness, and pain, should increase the index of suspicion of IEM (8). High-resolution ultrasonography is a low-cost and reliable method for establishing the suspicion of an IEM diagnosis (9). Complete surgical excision is accepted as a curative treatment (10). The majority of authors indicated groin incision and exploratory surgery, with the removal of a portion of the round ligament described in almost half of the patients (11). Medical treatment including progestogens should be reserved for patients who do not want surgery (3). Conclusion This case study demonstrates the importance of focusing on inguinal endometriosis in the differential diagnosis of inguinal masses in women with cyclical worsening of pain coinciding with menstruation. Clinicians can combine common clinical symptoms and signs with ultrasound results to establish an IEM diagnosis; this is particularly beneficial in low-resource countries such as ours, where CT and MRI are expensive and not widely available. Preoperative imaging may be useful, but the final diagnosis can be confirmed only after surgical excision and histopathology. Multidisciplinary collaboration, a high degree of suspicion, and meticulous surgical techniques are crucial for the successful management of inguinal endometriosis, ensuring optimal patient outcomes. Abbreviations IEM- inguinal endometriosis DMPA - depot medroxyprogesterone acetate CT- Computed tomography MRI- Magnetic resonance imaging Declarations Ethics approval and consent to participate – Not applicable Consent for publication- Yes Availability of data and materials- Not Applicable Competing interests- None Funding- No funding received Authors' contributions NR was the gynecologist and IK was the pathologist NS was the surgeon involved in the management.EG was the middle grade gynaecologist involved. NR wrote the manuscript. IK provided the histopathology pictures. DG and IC were junior doctors involved in the management and took the photographs during the surgery. All authors read and approved the final manuscript. Acknowledgements Mrs MKOK De Silva provided the witting support with the manuscript and edited the manuscript. Authors' information (optional) Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka Nilan Kalidasa Rodrigo, Iranthi Kumarasinghe, Nadeeja, Eranda Gunasekera University Hospital - Kotelawala Defence University- Werahera, Sri Lanka Nadeeja Samarasekeara, Dinuka Gunawansa , Iyan Chamikara References Blanco RG, Parithivel VS, Shah AK, Gumbs MA, Schein M, Gerst PH. Abdominal wall endometriomas. The American journal of surgery. 2003;185(6):596-8. Andres MP, Arcoverde FV, Souza CC, Fernandes LFC, Abrao MS, Kho RM. Extrapelvic endometriosis: a systematic review. Journal of minimally invasive gynecology. 2020;27(2):373-89. Arakawa T, Hirata T, Koga K, Neriishi K, Fukuda S, Ma S, et al. Clinical aspects and management of inguinal endometriosis: A case series of 20 patients. Journal of Obstetrics and Gynaecology Research. 2019;45(10):2029-36. Lamceva J, Uljanovs R, Strumfa I. The main theories on the pathogenesis of endometriosis. International journal of molecular sciences. 2023;24(5):4254. Niitsu H, Tsumura H, Kanehiro T, Yamaoka H, Taogoshi H, Murao N. Clinical characteristics and surgical treatment for inguinal endometriosis in young women of reproductive age. Digestive Surgery. 2019;36(2):166-72. Savelli L, Manuzzi L, Di Donato N, Salfi N, Trivella G, Ceccaroni M, Seracchioli R. Endometriosis of the abdominal wall: ultrasonographic and Doppler characteristics. Ultrasound in obstetrics & gynecology. 2012;39(3):336-40. Mourra N, Cortez A, Bennis M, Guettier C, Zaatari G, Duvillard P, et al. The groin: an unusual location of endometriosis—a multi-institutional clinicopathological study. Journal of Clinical Pathology. 2015. Miranda L, Settembre A, Capasso P, Piccolboni D, De Rosa N, Corcione F. Inguinal endometriosis or irreducible hernia? A difficult preoperative diagnosis. Hernia. 2001;5(1):47-9. Li S-H, Sun H-Z, Li W-H, Wang S-Z. Inguinal endometriosis: ten case reports and review of the literature. World Journal of Clinical Cases. 2021;9(36):11406. Horton JD, DeZee KJ, Ahnfeldt EP, Wagner M. Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases. The American Journal of Surgery. 2008;196(2):207-12. Dalkalitsis A, Salta S, Tsakiridis I, Dagklis T, Kalogiannidis I, Mamopoulos A, et al. Inguinal endometriosis: A systematic review. Taiwanese Journal of Obstetrics and Gynecology. 2022;61(1):24-33. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4050569","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":277804586,"identity":"a300e891-ba8b-451e-9ace-6ec624d18786","order_by":0,"name":"Nilan Rodrigo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYDACZuYGCOMAI5BRkcAI4RYk4NHCiKzlDEyLAR4tDHAtIHYbEVrM2RkbPxcw3JPju324+cXHeWmyGw4wP/zAYJCGU4tlM2Oz9AyGYmPJc4ltljO35RhvOMBmLMFgkINTi8FhxgZpHoaExA1nGNuMebdVJG44wGAGFK/Ap6X5N0LLHJAW9m+EtLTBbGl+zNuQA9TCA7IFr8ParHkMEowlgbYwzjiWZjzzME+xRAIe7xucP3z4Nk9FghzfGfbHHz7UJMv2HW/f+OFDRTJOLVCNYJJNAkwxA3ECAQ0wwPyBSIWjYBSMglEwwgAACmNUbSigVWUAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-3214-4415","institution":"General Sir John Kotelawala Defence University","correspondingAuthor":true,"prefix":"","firstName":"Nilan","middleName":"","lastName":"Rodrigo","suffix":""}],"badges":[],"createdAt":"2024-03-09 01:28:51","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4050569/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4050569/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52448082,"identity":"4b6b85c5-e590-4325-b404-3d89368e0e2e","added_by":"auto","created_at":"2024-03-11 18:35:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":4057300,"visible":true,"origin":"","legend":"\u003cp\u003ePhoto graphs taken during surgery. \u003cstrong\u003eA\u003c/strong\u003e Endometriosis mass attached to the round ligament emerging from deep inguinal ring. \u003cstrong\u003eB \u003c/strong\u003eDissected out inguinal mass\u003c/p\u003e","description":"","filename":"Fig.1.png","url":"https://assets-eu.researchsquare.com/files/rs-4050569/v1/5402437ec1696963a5bf3ef2.png"},{"id":52448081,"identity":"36414c9b-6cba-4bbd-8a2d-69a9792911e4","added_by":"auto","created_at":"2024-03-11 18:35:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2543832,"visible":true,"origin":"","legend":"\u003cp\u003eHistopathology of the mass. \u003cstrong\u003eA\u003c/strong\u003e Low magnification. \u003cstrong\u003eB\u003c/strong\u003e higher magnification. Showing endometrial glands and stroma within smooth muscle of the round ligament.\u003c/p\u003e","description":"","filename":"Fig.2.png","url":"https://assets-eu.researchsquare.com/files/rs-4050569/v1/c2c9291483efe7284e719675.png"},{"id":52448390,"identity":"b5c67014-e675-426c-8e04-f86141cdea38","added_by":"auto","created_at":"2024-03-11 18:43:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5075638,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4050569/v1/edf91219-7071-4a5a-aad4-cddf8076b3e2.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eA case report of Inguinal Endometriosis-A rare entity of a common condition\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInguinal endometriosis was first described by Blanco et al. in 1986(1). Inguinal endometriosis is a very rare condition in which fewer than 150 cases have been reported in the literature as of 2020, (2), often presenting diagnostic challenges (3). This case report details the clinical course of a 46-year-old woman with a painful inguinal lump, highlighting the importance of accurate diagnosis and multidisciplinary collaboration in managing this condition.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 46-year-old woman, who underwent a caesarean section 15 years prior presented to our hospital gynaecology clinic with a painful lump in her right groin for 5 years, aggravated during menstruation and exacerbated by coughing and sneezing. She sought treatment at two teaching hospitals 3 years apart. In the first hospital, she received a depot methylprednisolone acetate injection, to which she did not respond. Two years later, she was taken to another teaching hospital for the excision of an endometriotic mass in her right inguinal area. Ultrasound revealed that the right femoral vein was 11 mm lateral to the lesion. However, excision was not performed because of the propensity for vascular injury. Instead, three doses of depot medroxyprogesterone acetate (DMPA) were administered at monthly intervals. The pain significantly improved with DMPA but she preferred surgical excision due to side effects of DMPA.\u003c/p\u003e\n\u003cp\u003eOn examination, there was a 3x3 cm tender subcutaneous mass in the right inguinal region 2 cm below the prior low suprapubic transverse incision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic Workup:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUltrasound performed at our hospital revealed a 26 mm x 14 mm x 24 mm hypoechoic lesion within the rectus muscle, situated 7 mm away from the femoral vein. The lesion breached the posterior wall of the rectus abdominis muscle without intraperitoneal extensions. Medially, the lesion was 5 mm away from the pubic bone. The pelvic organs appeared normal.\u003c/p\u003e\n\u003cp\u003eA provisional diagnosis of right inguinal endometriosis was made, and surgical excision was planned in consultation with a surgeon.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical Intervention:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 7 cm transverse incision, parallel to the existing previous caesarean scar, was made in the right groin. The 45x25x25 mm mass, with irregular black and blue regions, was located superior to the aponeurosis of the external oblique muscle, linked medially to the pubic tubercle, and laterally to the round ligament. Meticulous dissection, including excision of a portion of the round ligament and normal fat tissue, was performed ( figure1). Continuous vigilance was exercised to avoid potential femoral vein injury. The deep inguinal ring was closed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHistopathology confirmed that the fibromuscular tissue contained endometrial glands and stroma (figure 2)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aetiology of inguinal endometriosis is uncertain. Several theories have been suggested, including the implantation theory, metaplasia within the round ligament, and retrograde menstruation (4). Niitsu et al (5) divided IEM into three types based on the location of the endometrial tissue: type I is a hernial sac or hydrocele in the Nuck canal, type II is in the round ligament, and type III is under the skin. IEM more commonly occurs on the right side, and the most prevalent is type II (6). This patient had type II disease according to Nitsu et al. (5), which supports the theory of metaplasia since endometriosis is confined to the round ligament (4).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;It is challenging to diagnose IEMs and IEMs are often prone to misdiagnosis, particularly because of the rarity of the condition and inconclusive ultrasound reporting (3, 7). Catamenial symptoms such as increased size, tenderness, and pain, should increase the index of suspicion of IEM (8). High-resolution ultrasonography is a low-cost and reliable method for establishing the suspicion of an IEM diagnosis (9).\u003c/p\u003e\n\u003cp\u003eComplete surgical excision is accepted as a curative treatment (10). The majority of authors indicated groin incision and exploratory surgery, with the removal of a portion of the round ligament described in almost half of the patients (11). Medical treatment including progestogens should be reserved for patients who do not want surgery (3).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case study demonstrates the importance of focusing on inguinal endometriosis in the differential diagnosis of inguinal masses in women with cyclical worsening of pain coinciding with menstruation. Clinicians can combine common clinical symptoms and signs with ultrasound results to establish an IEM diagnosis; this is particularly beneficial in low-resource countries such as ours, where CT and MRI are expensive and not widely available. Preoperative imaging may be useful, but the final diagnosis can be confirmed only after surgical excision and histopathology. Multidisciplinary collaboration, a high degree of suspicion, and meticulous surgical techniques are crucial for the successful management of inguinal endometriosis, ensuring optimal patient outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIEM- inguinal endometriosis\u003c/p\u003e\n\u003cp\u003eDMPA\u003cstrong\u003e-\u0026nbsp;\u003c/strong\u003edepot medroxyprogesterone acetate\u003c/p\u003e\n\u003cp\u003eCT-\u0026nbsp;Computed tomography\u003c/p\u003e\n\u003cp\u003eMRI- Magnetic resonance imaging\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003eEthics approval and consent to participate \u0026ndash; Not applicable\u003c/li\u003e\n \u003cli\u003eConsent for publication- Yes\u003c/li\u003e\n \u003cli\u003eAvailability of data and materials- Not Applicable\u003c/li\u003e\n \u003cli\u003eCompeting interests- None\u003c/li\u003e\n \u003cli\u003eFunding- No funding received\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNR was the gynecologist and IK was the pathologist NS was the surgeon involved in the management.EG was the middle grade gynaecologist involved. NR wrote the manuscript. IK provided the histopathology pictures. DG\u0026nbsp;and IC were junior doctors involved in the management and took the photographs during the surgery.\u0026nbsp;All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMrs MKOK De Silva provided the witting support with the manuscript and edited the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e (optional)\u003c/p\u003e\n\u003cp\u003eDepartment of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka\u003c/p\u003e\n\u003cp\u003eNilan Kalidasa Rodrigo, Iranthi Kumarasinghe, Nadeeja, Eranda Gunasekera\u003c/p\u003e\n\u003cp\u003eUniversity Hospital - Kotelawala Defence University- Werahera, Sri Lanka\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNadeeja Samarasekeara, Dinuka Gunawansa , Iyan Chamikara\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBlanco RG, Parithivel VS, Shah AK, Gumbs MA, Schein M, Gerst PH. Abdominal wall endometriomas. The American journal of surgery. 2003;185(6):596-8.\u003c/li\u003e\n\u003cli\u003eAndres MP, Arcoverde FV, Souza CC, Fernandes LFC, Abrao MS, Kho RM. Extrapelvic endometriosis: a systematic review. Journal of minimally invasive gynecology. 2020;27(2):373-89.\u003c/li\u003e\n\u003cli\u003eArakawa T, Hirata T, Koga K, Neriishi K, Fukuda S, Ma S, et al. Clinical aspects and management of inguinal endometriosis: A case series of 20 patients. Journal of Obstetrics and Gynaecology Research. 2019;45(10):2029-36.\u003c/li\u003e\n\u003cli\u003eLamceva J, Uljanovs R, Strumfa I. The main theories on the pathogenesis of endometriosis. International journal of molecular sciences. 2023;24(5):4254.\u003c/li\u003e\n\u003cli\u003eNiitsu H, Tsumura H, Kanehiro T, Yamaoka H, Taogoshi H, Murao N. Clinical characteristics and surgical treatment for inguinal endometriosis in young women of reproductive age. Digestive Surgery. 2019;36(2):166-72.\u003c/li\u003e\n\u003cli\u003eSavelli L, Manuzzi L, Di Donato N, Salfi N, Trivella G, Ceccaroni M, Seracchioli R. Endometriosis of the abdominal wall: ultrasonographic and Doppler characteristics. Ultrasound in obstetrics \u0026amp; gynecology. 2012;39(3):336-40.\u003c/li\u003e\n\u003cli\u003eMourra N, Cortez A, Bennis M, Guettier C, Zaatari G, Duvillard P, et al. The groin: an unusual location of endometriosis\u0026mdash;a multi-institutional clinicopathological study. Journal of Clinical Pathology. 2015.\u003c/li\u003e\n\u003cli\u003eMiranda L, Settembre A, Capasso P, Piccolboni D, De Rosa N, Corcione F. Inguinal endometriosis or irreducible hernia? A difficult preoperative diagnosis. Hernia. 2001;5(1):47-9.\u003c/li\u003e\n\u003cli\u003eLi S-H, Sun H-Z, Li W-H, Wang S-Z. Inguinal endometriosis: ten case reports and review of the literature. World Journal of Clinical Cases. 2021;9(36):11406.\u003c/li\u003e\n\u003cli\u003eHorton JD, DeZee KJ, Ahnfeldt EP, Wagner M. Abdominal wall endometriosis: a surgeon\u0026apos;s perspective and review of 445 cases. The American Journal of Surgery. 2008;196(2):207-12.\u003c/li\u003e\n\u003cli\u003eDalkalitsis A, Salta S, Tsakiridis I, Dagklis T, Kalogiannidis I, Mamopoulos A, et al. Inguinal endometriosis: A systematic review. Taiwanese Journal of Obstetrics and Gynecology. 2022;61(1):24-33.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"General Sir John Kotelawala Defence University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"extrapelvic, inguinal, endometriosis, round ligament, surgical excision","lastPublishedDoi":"10.21203/rs.3.rs-4050569/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4050569/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e This case report discusses the presentation, diagnostic challenges, and successful surgical management of inguinal endometriosis(IEM).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation:\u003c/strong\u003e A 46-year-old Sinhalese woman experienced a painful lump in the right groin area for 5 years, with exacerbation during menstruation, coughing, and sneezing. Initial treatment, with depot methylprednisolone acetate injection, was ineffective. Two years later, at a different hospital, an endometriotic mass was identified in the right inguinal region, excision was not performed because of the propensity for vascular injury instead three doses of depot medroxyprogesterone acetate(DMPA) significantly alleviated the pain. When she presented to our hospital, a provisional diagnosis of right inguinal endometriosis was made after an ultrasound examination. A multidisciplinary approach involving a surgeon was employed for excision surgery, with meticulous attention given to avoiding femoral vein injury. The 45x25x25 mm mass, located in the inguinal ligament, was successfully removed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: This case underscores the importance of collaboration between specialties for accurate diagnosis and effective surgical management of inguinal endometriosis. Preoperative imaging is useful, but the final diagnosis can be confirmed only after surgical excision and histopathology\u003c/p\u003e","manuscriptTitle":"A case report of Inguinal Endometriosis-A rare entity of a common condition","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-11 18:35:07","doi":"10.21203/rs.3.rs-4050569/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f6e7b687-4306-4c45-a9ad-40ba42e071a7","owner":[],"postedDate":"March 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":29250635,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2024-03-11T18:35:07+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-11 18:35:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4050569","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4050569","identity":"rs-4050569","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}