A 24-year-old woman was initially found to have a right inguinal hernia that occurred suddenly after heavy lifting. A right direct inguinal hernia was found during the initial operative procedure. The round ligament was excised, the internal ring was closed, and the hernia was repaired with mesh placed on the floor of the inguinal canal. Four months after an uneventful postoperative recovery, the patient returned with pain in the right inguinal area. Over the next 2 months, a deep painful bulge developed. Inguinal exploration revealed an endometrioma rather than recurrent inguinal hernia. A portion of the original hernia incision included part of a previous Pfannenstiel incision made 3 years previously for a cesarean section. Scar endometriosis most probably occurred from peritoneal seeding from the Pfannenstiel incision and mimicked the findings of a recurrent inguinal hernia.
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