17 December 2021
: Case report 
Inguinal Endometriosis in a Nulliparous Woman Mimicking an Inguinal Hernia: A Case Report with Literature Review
Challenging differential diagnosis, Rare disease, Clinical situation which can not be reproduced for ethical reasons
Fatima M. AlSinan1BDEF, Abdulelah S. Alsakran2BDEF, Mohammed S. Foula
2ADE*, Tahseen M. Al Omoush3D, Hassan Al-Bisher2ACDE
DOI: 10.12659/AJCR.934564
Am J Case Rep 2021; 22:e934564
Table 1. Clinical data of patients with inguinal endometriosis from published literature.
| Year | No of reported cases | Age/parity/location | Presentation | Duration | Menstrual/obstetric history | Surgical history | |
|---|---|---|---|---|---|---|---|
| 1 | 2021 Swatesutipun V, et al []24 | 1 | 34 Unknown Right | Groin mass with cyclical pain | 2 years | Regular | NA |
| 2 | 2021 Skarpas AS, et al []25 | 1 | 42 Unknown Right | Groin mass, cyclical pain | 3 years | NA | NA |
| 3 | 2020 Nigam VK, et al []26 | 1 | 40 Multiparous Right | Painful groin mass, no cyclical change | 1 month | Normal, regular cycle | CS |
| 4 | 2020 Basnayake O, et al []3 | 1 | 27 Unknown Right | Painful groin mass, no cyclical change | 4 months | Dyspareunia, infertility | no |
| 5 | 2020 Zihni İ, et al []27 | 1 | 31 Multiparous Right | Painful groin mass, no cyclical change | 1 year | NA | C.S |
| 6 | 2020 Fujikawa H, et al []4 | 1 | 42 Unknown Right | Groin pain | 1 year | NA | NA |
| 7 | 2019 Thomas JA, et al []28 | 1 | 23 Unknown Right | Painful groin mass, no cyclical change | 1 year | NA | NA |
| 8 | 2019 Fong KN, et al []23 | 1 | 41 Multiparous Right | Groin mass, no cyclical change | 1 month | Dyspareunia, infertility | no |
| 9 | 2019 Azhar E, et al []29 | 1 | 33 Multiparous Right | RLQ pain | 2 days | Endometriosis infertility | Laparoscopic excision of pelvic endometrioma |
| 10 | 2019 Nagama T, et al []30 | 1 | 41 Unknown Right | Painful groin mass, no cyclical change | 10 years | NA | Right inguinal hernia repair |
| 11 | 2019 Raviraj S, et al []31 | 1 | 30 Unknown Right | Painful groin mass, cyclical pain | 5 months | Infertility | NA |
| 12 | 2019 Arakawa T, et al []18 | 20 | Avg. 25–46 Nulliparous 17/20 Multiparous 3/20 Right 13/20 Left 5/20 Bilateral 2/20 | Groin pain 20/20 Groin mass 14/20 Cyclical variation in symptoms in 16/20 | NA | Ovarian endometrioma 11/20 Dysmenorrhea 14/20 | C.S 1/20 Laparotomy 1/20 Laparoscopy 3/20 No past surgical history 15/20 |
| 13 | 2018 Wolfhagen, et al []11 | 9 | 28 unknown right | Painful groin mass, no cyclical change | 1 month- 2 years | NA | NA |
| 36 Nulliparous left | Painful groin mass, cyclical pain | NA | NA | ||||
| 43 Unknwon Right | Groin mass, no cyclical change | NA | NA | ||||
| 27 Nuliparous Right | Groin mass, no cyclical change | NA | NA | ||||
| 30 Nuliparous Right | Groin mass, no cyclical change | NA | NA | ||||
| 32 Nuliparous Left | Painful groin mass, cyclical pain | Dysmenorrhea, dyspareunia | no | ||||
| 29 Multiparous Right | Painful groin mass, cyclical pain | NA | CS | ||||
| 36 Unknwon Right | Painful groin mass, cyclical pain | NA | NA | ||||
| 32 Unknwon Right | Painful groin mass, cyclical pain | NA | NA | ||||
| 14 | 2017 Ion D, et al []32 | 1 | 42 Nuliparous Right | Painful groin mass, cyclical change in size and pain | 3 months | Infertility | NA |
| 15 | 2017 Okoshi K, et al []12 | 1 | 44 Multiparous Right | Painful groin mass, cyclical pain | NA | Endometriosis, irregual cycles | laproscopic excision of pelvic endometrioma |
| 16 | 2016 Kilic mo, et al []33 | 1 | 35 Unknwon Right | Painful groin mass, cyclical change in size and pain | 2 years | Endometriosis | laproscopic excision of pelvic endometrioma |
| 17 | 2016 Tsuchie H, et al []34 | 1 | 45 Multiparous Right | Painful groin mass, cyclical pain | 1 year | NA | NA |
| 18 | 2015 Husain F, et al []7 | 1 | 32 Multiparous Right | Painful groin mass, cyclical change in size and pain | 2 years | NA | CS |
| 19 | 2015 Pandey D, et al []9 | 1 | 39 Multiparous Left | Painful groin mass, cyclical change in size and pain | 6 months | Normal, regular cycle | CS |
| 20 | 2014 Albutt K, et al []5 | 1 | 23 Unknwon Left | Painful groin mass, nausea, fever and chills | 4 days | NA | no |
| 21 | 2014 Kim DH, et al []13 | 1 | 40 Nuliparous Right | Painful groin mass, cyclical pain | 2 years | Regualr, menorrhagia | no |
| 22 | 2014 Borghans RA, et al []35 | 1 | 28 Unknwon Right | Painful groin mass, cyclical change in size and pain | 1 year | NA | NA |
| 23 | 2013 Al-Ibrahim NT []36 | 1 | 29 Nuliparous Right | Painful groin mass, cyclical change in size | 2 years | Normal, regular cycle | NA |
| 24 | 2013 Stojanovic M, et al []6 | 1 | 40 Unknwon Right | Painful groin mass, cyclical pain | 2 years | NA | Myomectomy |
| 25 | 2013 Prabhu R, et al []8 | 1 | 49 Multiparous Left | Painful groin mass, cyclical change in size | 6 months | Normal, regular cycle | CS |
| 26 | 2012 Rajendran S, et al []37 | 1 | 36 Unknwon Left | Painful groin mass, cyclical change in size and pain | 3 years | Hystrectomy | Hystrectomy |
| 27 | 2011 Wong WS, et al []19 | 1 | 48 Multiparous Right | Painful groin mass, cyclical pain | 8 weeks | Metomeno-rrhagia | NA |
| 28 | 2009 Wang CJ, et al []14 | 1 | 35 Unknwon Left | Painful groin mass, no cyclical changes | 6 months | Regular cycle with dysmenorreha | NA |
| 29 | 2009 Apostolidis S, et al []38 | 3 | 36 Multiparous Right | Groin mass, gradually enlarging | 1 year | Normal, regular cycle | NA |
| 37 Nuliparous Right | Cyclic groin pain | 3 year | Dysmenorreha | NA | |||
| 41 Multiparous Right | Painful groin mass, no cyclical changes | 4 months | Endometriosis | Bilateral oopherectomy for endometriosis | |||
| 30 | 2008 Kaushik R, et al []39 | 1 | 37 Multiparous Right | Painful groin mass, cyclical pain | 5 years | NA | CS, excision of a similar mass without pathology |
| 31 | 2007 Mashfiqul MA, et al []21 | 1 | 37 Unknwon Right | Painful groin mass, no cyclical changes | 2 months | NA | NA |
| 32 | 2007 Hagiwara Y, et al []10 | 1 | 28 unknwon right | Painful groin mass, cyclical change in size and pain | 7 months | Endometriosis, dysmenorrhea | Laprosocpic left ovarian cystectomy, adhesiolysfor endometriosis |
| 33 | 2007 Ducarme G, et al []22 | 1 | 28 Multiparous right | Groin mass, cyclical change in size and pain | 6 months | Normal, regular cycle | CS+hernia repair |
| 34 | 2006 Ku J, et al []40 | 1 | 46 Multiparous right | Groin and RLQ pain | 2 days | Normal, regular cycle | NA |
| 35 | 2005 Licheri S, et al []16 | 1 | 29 Nuliparous right | Painful groin mass, cyclical change in size and pain | 1 year | Endometriosis, dysmenorreha on hormonal therapy | NA |
| 36 | 2005 Kapan M, et al []41 | 3 | 39 unknwon right | Painful groin mass, cyclical change in size | 5 years | NA | NA |
| 42 unknwon right | Groin mass, gradually enlarging | 4 years | NA | NA | |||
| 51 unknwon left | Groin mass, no cyclical changes | 7 years | NA | NA | |||
| 37 | 2002 Hagiwara Y, et al []17 | 1 | 40 Multiparous right | Painful groin mass, no cyclical changes | 2 years | Endometriosis | Laproscopy |
| 38 | 2001 Boggi U, et al []42 | 2 | 35 Multiparous right | painful mass in labium, cyclical pain | months | NA | CS |
| 30 unknwon right | Painful groin mass, cyclical pain | 4 months | NA | NA | |||
| 39 | 2000 Ling CM, et al []43 | 1 | 46 Multiparous right | Painful RLQ mass, cyclical change in size and pain | 4 months | Regular, dysmenorrhea | no |
| 40 | 1996 Freed KS, et al []20 | 1 | 45 Multiparous right | Groin mass, no cyclical changes | several years | Normal, regular cycle | NA |
| 41 | 1994 Goh JT, et al []44 | 1 | 22 Unknwon Right | Painful groin mass, cyclical change in size and pain | 2 years | Normal, regular cycle | NA |
| 42 | 1994 Imai A, et al []45 | 1 | 39 Unknwon Right | Painful groin mass, cyclical change in size and pain | 1 year | NA | NA |
| 43 | 1991 Mitchell AO, et al []46 | 1 | 24 Unknwon Right | Painful groin mass, no cyclical changes | 4 months | NA | NA |
| 44 | 1985 Quagliarello J, et al []47 | 1 | 24 Multiparous Right | Painful groin mass, no cyclical changes | 3 weeks | Normal, regular cycle | NA |
| 45 | 1983 Brzezinski A, et al. []48 | 1 | 41 Nuliparous Right | Painful groin mass, gradually enlarging | 1 year | Normal, regular cycle | NA |
| 46 | 1978 Clausen I, et al []49 | 1 | 29 Unknwon Right | Painful groin mass, cyclical pain | 4.5 years | Normal, regular cycle | NA |
| 47 | 1956 Dormandy TL, et al []15 | 3 | 38 Multiparous Right | Painful groin mass, cyclical change in size and pain | 15 years | Normal, regular cycle | Right tubal pregnancy |
| 49 Nulliparous Right | Painful groin mass, cyclical change in size and pain | 3 months | Normal, regular cycle | no | |||
| 40 Nulliparous Right | Painful groin mass, cyclical pain | 3–4 years | NA | NA | |||
| FNAC – fine-needle aspiration cytology; NA – not available; US – ultrasonography;MRI – magnetic resonant imaging; CT – computed tomography; CS – cesarean section; OCP – oral contraceptive pills; RLQ – right lower quadrant of the abdomen; TAH BSO – total abdominal hysterectomy with bilateral salpingo-oophrectomy; PO – postoperative; LN – lymph node | |||||||
| Pre-operative diagnosis | Imaging modalities/findings/further accuracy | Pre-operative FNAC | Operation | Hernia presence and repair | Follow up/management | ||
| 1 | Nuck’s canal cyst | US, MRIGroin cystic swellingInconclusive | NA | Excision of mass | No | NA | |
| 2 | Inguinal hernia | NA | NA | Excision of mass | No | NA | |
| 3 | Incarcerated right inguinal hernia f | US, CTIncarcerated inguinal herniaInconclusive | NA | Excision of mass | Yes | NA | |
| 4 | Hydrocele of canal of nuck | USGroin cystic swellingInconclusive | NA | Excision of mass | Na | Asymptomatic OCP | |
| 5 | Inguinal hernia with cystic lesion | USInguinal hernia, Groin cystic swellingInconclusive | NA | Excision of mass | Yes | Asymptomatic | |
| 6 | Inguinal hernia versus lymphadenopathy | US, MRIGroin massInconclusive | NA | Excision of mass with wide surgical margin | Yes | Asymptomatic | |
| 7 | Inguinal endometriosis | MRIInguinal endometriosisDiagnostic | NA | Excision of mass | No | NA | |
| 8 | Inguinal hernia and abscess | NA | NA | Incision of drainage of the mass with excision of the fibrous wall of the mass | No | Asymptomatic | |
| 9 | Ovarian torsion, incarcerated inguinal hernia, endometrioma | CT, MRISuspected femoral herniaInconclusive | NA | Excision of mass and round ligament | Yes | Asymptomatic | |
| 10 | NA | MRIInconclusive | NA | excision of mass | No | Asymptomatic | |
| 11 | Inguinal hernia | USGroin cystic swelling, chocolate cystNot conclusive | NA | excision of mass | No | NA | |
| 12 | NA | 18/20: US, Inconclusive13/20: CT, inguinal mass18/20: MRI | NA | 6/20 excision of mass and round ligament 3/20 TAH BSO and excision of mass | No | 3/20 OCP 1/20 recurrence after 8 m | |
| 13 | NA | US, MRIInconclusive | NA | Excision of mass | Yes | Cyclical pain around scar | |
| Inguinal hernia or endometriosis | USInguinal hernia versus endometriosisInconclusive | NA | Excision of mass | Yes | NA | ||
| Leiomyoma | US, MRILeiomyomaInconclusive | NA | Excision of mass | No | Irregular menstrual cycle | ||
| Inguinal LN or sabecious cyst | USInguinal LNInconclusive | Endometriosis | Excision of mass | No | Asymptomatic | ||
| NA | NA | NA | Excision of mass | No | NA | ||
| Cyst of nuck or lymph node | US, MRIInguinal LN versus groin cystic swellingInconclusive | NA | Excision of mass | Yes | Endometriosis, infertility | ||
| Inguinal hernia | USInguinal herniaInconclusive | NA | Excision of mass | Yes | NA | ||
| Cyst of nuck | USGroin cystic swellingInconclusive | NA | Excision of mass | No | NA | ||
| Incarcerated inguinal hernia | US, MRIIncarcerated inguinal herniaInconclusive | Inconclusive | Excision of mass | No | Irregular menstrual cycle | ||
| 14 | Inguinal or femoral hernia | NA | NA | Excision of mass and round ligament | yes | Asymptomatic | |
| 15 | Hydrocyele, endomstriosis, incarcinated hernia | CTGroin cystic swellingInconclusive | NA | Excision of mass and round ligament | no | Asymptomatic | |
| 16 | Incarcerated Inguinal Hernia | US, MRIGroin cystic swellingInconclusive | NA | Excision of mass with wide margin | no | Asymptomatic | |
| 17 | Desmoid Tumor | MRIDesmoid tumorInconclusive | NA | Excision of mass | no | Cyclic pain | |
| 18 | Incarcerated Incisional Hernia And Endometrioma | MRIGroin massInconclusive | NA | Excision of mass | no | Asymptomatic | |
| 19 | Inguinal Endometriosis | US, MRIGroin massInconclusive | Endometriosis | Excision of mass and round ligament | no | Asymptomatic | |
| 20 | Inguinal Hernia | US, CTGroin cystic swellingInconclusive | NA | Excision of mass | yes | OCP | |
| 21 | Hemangioma, AV malformation | USGroin cystic swellingInconclusive | NA | Excision of mass and round ligament | no | Asymptomatic OCP | |
| 22 | Inguinal hernia, endometriosis | MRIInguinal hernia versus inguinal endometriosisInconclusive | NA | Excision of mass | NA | Asymptomatic | |
| 23 | NA | USUnremarkableInconclusive | Inconclusive | Excision of mass | NA | Cyclic pain | |
| 24 | NA | NA | NA | Excision of mass | NA | Asymptomatic | |
| 25 | Inguinal hernia, lipoma, neurofibroma, desmoid tumor, primary lymphoma | USGroin cystic swellingInconclusive | NA | Excision of mass | no | Asymptomatic | |
| 26 | Endometriosis | USGroin massInconclusive | Endometriosis | Patient refused surgical management | NA | Asymptomatic | |
| 27 | Endometriosis | USunremarkableInconclusive | Endometriosis | Excision of mass | no | Asymptomatic | |
| 28 | Inguinal endometrsiosis | US, CTGroin cystic swellingInconclusive | Endometriosis | Excision of mass | NA | Laparoscopy OCP | |
| 29 | Inguinal hernia | NA | NA | Excision of mass | No | NA | |
| Inguinal hernia | NA | NA | Excision of mass | Yes | NA | ||
| Inguinal hernia | NA | NA | Excision of mass | No | NA | ||
| 30 | Desmoid tumer | USGroin cystic swellingInconclusive | inconclusive | Excision of mass | no | Laparoscopy | |
| 31 | Inguinal hernia | USSpigelian herniaInconclusive | NA | Excision of mass and round ligament | No | Laparoscopy asymptomatic | |
| 32 | Inguinal hernia, desmoid tumor, hemangioma, endometriosis | CT, MRIGroin massInconclusive | NA | Excision of mass and round ligament | No | Asymptomatic | |
| 33 | NA | US, MRIGroin massInconclusive | NA | Excision of mass | Yes | Asymptomatic | |
| 34 | Irreducible direct inguinal hernia | US, CTStrangulated direct inguinal herniaInconclusive | NA | Excision of mass | No | Asymptomatic | |
| 35 | Endometriosis of the round ligament | US, MRIEndometriosis of round ligamentDiagnostic | NA | Excision of mass and round ligament | No | Asymptomatic | |
| 36 | Inguinal hernia | USInguinal herniaInconclusive | NA | Excision of mass and round ligament | NA | Asymptomatic | |
| Inguinal hernia | NA | NA | Excision of mass and round ligament | Yes | NA | ||
| Inguinal hernia | NA | NA | Excision of mass and round ligament | NA | NA | ||
| 37 | Inguinal hernia, dermoid tumor, hemangioma | CT, MRIGroin massInconclusive | NA | Excision of mass and round ligament | No | Asymptomatic | |
| 38 | Extrapelvic endomestrosis | USGroin cystic swellingInconclusive | NA | Exicison of lump and heria sac excision | Yes | Asymptomatic | |
| NA | NA | NA | Excision of mass | Yes | Asymptomatic | ||
| 39 | NA | USGroin cystic swellingInconclusive | NA | Excision of mass | Yes | Asymptomatic | |
| 40 | Endometriosis | US, CTGroin cystic swellingInconclusive | Endometriosis | Excision of mass | No | Laparoscopy | |
| 41 | Endometriosis | NA | NA | Excision of mass | No | Asymptomatic | |
| 42 | Endometriosis | US, MRIEndometriosisDiagnostic | NA | Excision of mass and round ligament | No | Laparoscopy | |
| 43 | Abscess | NA | NA | Excision of mass | No | NA | |
| 44 | Right inguinal LN | USGroin cystic swellingInconclusive | NA | Excision of mass | Yes | Laparoscopy | |
| 45 | NA | NA | NA | Excision of mass | Yes | NA | |
| 46 | NA | NA | NA | Excision of mass and round ligament | No | Asymptomatic | |
| 47 | Endomestriosis of the canal of nuck | NA | NA | Excision of mass and round ligament | Yes | Asymptomatic | |
| Endomestriosis of the canal of nuck | NA | NA | Excision of mass | Yes | Asymptomatic | ||
| NA | NA | NA | Excision of mass and round ligament | Yes | Asymptomatic | ||
| FNAC – fine-needle aspiration cytology; NA – not available; US – ultrasonography;MRI – magnetic resonant imaging; CT – computed tomography; CS – cesarean section; OCP – oral contraceptive pills; RLQ – right lower quadrant of the abdomen; TAH BSO – total abdominal hysterectomy with bilateral salpingo-oophrectomy; PO – postoperative; LN – lymph node | |||||||