Title : Strategic approach to diagnosis and management of abdominal wall endometriomas: A case series
Abstract:
This case series presents six cases of abdominal wall endometriosis (AWE), a unique condition characterized by the presence of endometrial tissue within the abdominal wall layers. The patients exhibited a spectrum of clinical presentations, ranging from cyclic abdominal pain and palpable masses with menstrual exacerbation of symptoms to persistent localized pain in a discrete area of the abdominal wall. All of these patients had prior cesarean sections as the underlying etiology causing endometrial implantation within the abdominal wall. Patients may or may not have concurrent pelvic endometriosis or pelvic symptoms.
Diagnostic modalities specifically ultrasound was crucial in identifying and characterizing the lesions, as well as planning wide local excision by determining the exact location, size and depth of the mass. Definitive diagnosis was established through histopathological analysis of excised tissue, all of which confirmed endometriosis. Surgical excision, the gold standard treatment, was employed in all cases, demonstrating its efficacy in alleviating symptoms and improving patient quality of life. Although hysterectomy may address the pelvic endometriosis and related symptomatology, hysterectomy alone is not an adequate treatment for AWE.
This case series aims to highlight the increasing incidence of abdominal wall endometriomas due to the growing frequency of cesarean sections and other pelvic surgeries. Our objective is to educate general gynecologists in maintaining a high index of suspicion for AWE in patients with localized pain in a discrete area of the abdominal wall, history of cesarean section, and especially in the background of confirmed or suspected pelvic endometriosis. This series underscores the importance of heightened clinical awareness, enhanced suspicion for AWE, employing targeted ultrasound, and en bloc surgical excision for complete relief.
