Inguinal Lump, Please Put an Endometriosis Extra Pelvic on Your Diagnosis List : Cases Series of Deep Endometriosis

Indra Adi Susianto, Neni Susilaningsih, Syarief Taufik Hidayat, Banundari Rachmawati
In: Malaysian Journal of Medicine and Health Sciences · 2025 · vol. 21(4) , pp. 399–401 · doi:10.47836/mjmhs.21.4.50 · W7126217101
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case series reports five instances of deep endometriosis presenting as inguinal masses in patients with prior endometriosis surgery, highlighting it as a differential diagnosis for inguinal hernias.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This paper reports five rare cases of extra-pelvic deep endometriosis presenting as an inguinal mass in patients who had undergone endometriosis surgery, with symptoms that varied with the menstrual cycle. Across cases, patients had an unclear, hard, elastic right inguinal mass (average size reported as 22.2 cm² at the bottom edge of the rectus abdominal muscle), and in one case they received dienogest (2 mg) for 180 days but the mass enlarged, leading to surgical management. The authors emphasize that the rarity of inguinal deep endometriosis is a key limitation, making differential diagnosis challenging, particularly for painful inguinal hernias, and they call for multidisciplinary collaboration to better understand and prevent recurrence. This paper is centrally about endometriosis — it is a case series of deep extra-pelvic (inguinal) endometriosis.

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Abstract

Deep Endometriosis is usually found in the ovaries, peritoneum, gynecological organs and in the pouch of Douglas. We have reported 5 rare cases of extra-pelvic endometriosis from 2018-2023 on a patient who had endometriosis surgery and suffered from a mass in her inguinal area, and the symptoms were going up and down along with the menstrual cycle. An unclear mass which was hard and elastic in the right side of inguinal area with an average diameter of 22.2 cm2 at the bottom edge of the rectus abdominal muscle. The patient was then given 2mm Dienogest therapy for 180 days and the mass tended to enlarge so that it was decided to undergo surgery. The rare incidence of DE at inguinal is one of the considerations as a differential diagnosis for painful inguinal hernias. Collaboration and multidisciplinary approach are needed to understand better and to find appropriate therapy to prevent a recurrence.
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Abstract

Deep Endometriosis is usually found in the ovaries, peritoneum, gynecological organs and in the pouch of Douglas. We have reported 5 rare cases of extra-pelvic endometriosis from 2018-2023 on a patient who had endometriosis surgery and suffered from a mass in her inguinal area, and the symptoms were going up and down along with the menstrual cycle. An unclear mass which was hard and elastic in the right side of inguinal area with an average diameter of 22.2 cm2 at the bottom edge of the rectus abdominal muscle. The patient was then given 2mm Dienogest therapy for 180 days and the mass tended to enlarge so that it was decided to undergo surgery. The rare incidence of DE at inguinal is one of the considerations as a differential diagnosis for painful inguinal hernias. Collaboration and multidisciplinary approach are needed to understand better and to find appropriate therapy to prevent a recurrence. Downloads Article Details

References

Hudelist G, Pashkunova D, Darici E, Rath A, Mitrowitz J, Dauser B, et al. Pain, gastrointestinal function and fertility outcomes of modified nerve-vessel sparing segmental and full thickness discoid resection for deep colorectal endometriosis - A prospective cohort study. Acta Obstet Gynecol Scand 2023. Keckstein J, Hudelist G. Classification of deep endometriosis (DE) including bowel endometriosis: From r-ASRM to #Enzian-classification. Best Pract Res Clin Obstet Gynaecol 2021;71:27-37. Li B, Zhang Y, Zhang L, Zhang L. Association between endometriosis and metabolic syndrome: a cross-sectional study based on the National Health and Nutrition Examination Survey data. Gynecol Endocrinol 2023;39:2254844. Privitera G, O'Brien K, Misajon R, Lin CY. Endometriosis Symptomatology, Dyspareunia, and Sexual Distress Are Related to Avoidance of Sex and Negative Impacts on the Sex Lives of Women with Endometriosis. Int J Environ Res Public Health 2023;20. Hagiwara Y, Hatori M, Moriya T, Terada Y, Yaegashi N, Ehara S, et al. Inguinal endometriosis attaching to the round ligament. Australas Radiol 2007;51:91-4.

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Outcome instruments

Enzian

Condition tags

endometriosis

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