Extrapelvic endometriosis presenting as a hernia: clinical reports and review of the literature.

Endometriosis is a common gynecologic diagnosis. Typical complaints of patients with pelvic endometriosis include dysmenorrhea, menstrual irregularities, dyspareunia, and infertility. Endometriosis may also occur in extrapelvic sites and cause unusual symptoms and diagnostic dilemmas. Endometriosis has been described in the inguinal region, and this is illustrated in the first case history. The tender inguinal masses often fluctuate with the menstrual cycle but the condition initially may be confused with an inguinal hernia. Treatment is surgical. Abdominal wall scar endometriosis, seen in the second case, has been described in patients after a wide variety of gynecologic procedures. This also is initially noted as a tender mass, usually fluctuating with menstruation, and is often confused with an incisional hernia. Again, surgery is the treatment of choice. Pathologic features of endometriosis are constant, regardless of location. Microscopically, endometrial glands and stroma, fibrosis, chronic inflammation, and old hemorrhage are seen. Familiarity with the unusual types of endometriosis is important to the general surgeon.