Inguinal Canal Endometriosis

Abstract

Study Objective

Demonstrate a successful laparoscopic removal of endometriosis from within the inguinal canal, underscore the importance of pre-operative MRI imaging, and provide education on anatomy and surgical technique.

Design

Step-by-step video explanation of a single patient undergoing a laparoscopic removal of endometriosis from the inguinal canal.

Setting

Operating room.

Patients or Participants

A single patient with MRI imaging revealing endometriosis invasion into the inguinal canal and local vasculature.

Interventions

The patient's abdomen was entered and vasculature was identified to prevent major bleeding. Appropriate exposure was achieved by transecting the round ligament to provide a landmark for the inguinal canal. The endometriosis was identified and dissected off the external iliac vasculature and the abdominal wall using the squeeze technique. The endometriosis was then dissected out of the inguinal canal, off the femoral artery, and then removed from the abdomen.

Post-operatively, the patient was started on norethindrone acetate to suppress any residual disease and prevent recurrence.

Measurements and Main Results

The patient noted immediate pain relief in the recovery room. One year post-operatively, patient continued to endorse pain relief and no signs of hernia.

Conclusion

Endometriosis within the inguinal canal is of rare occurrence. It typically presents as a groin lump or pain that is worse with menstruation. As the endometriosis is in close proximity to the abdominal wall and local vasculature, MRI imaging, as well as general surgery and vascular surgery consultation, are necessary for proper surgical planning. These are difficult operations that require proper understanding of pelvic and inguinal canal anatomy.