Objective To evaluate the safety and efficacy of ultrasound‐guided high‐intensity focused ultrasound (USgHIFU) for treating abdominal wall endometrioses (AWE). Design A retrospective study. Setting Department of Obstetrics and Gynaecology in China. Population Patients with abdominal wall endometriosis. Methods From August 2010 to April 2014, 32 patients with AWE were treated with USgHIFU in our hospital. USgHIFU treatment was performed with the Model JC‐200 High Intensity Focused Ultrasound Tumor Therapeutic System. The symptom relief and the adverse effects were evaluated after USgHIFU ablation. Main outcome measures USgHIFU as a new treatment option for patients with AWE. Results Contrast‐enhanced ultrasound showed that all lesions were successfully ablated with USgHIFU. The follow‐up results showed that the average volume of AWE lesions at 6 months after USgHIFU was significantly smaller than that before treatment (2.80 ± 0.12 versus 1.33 ± 0.31 cm3). The pain scores at 6 months after treatment were significantly lower than those before treatment (6.80 ± 2.64 versus 1.80 ± 0.3). The non‐perfused volume (indicative of successful ablation) was measured in all patients immediately after treatment, ranging from 0.9 to 2.1 cm3 (median: 1.6 cm3), and the fractional ablation ranged from 87% to 100% (median: 94%). Local oedema was observed in these patients, lasting for 1–3 days only. No severe complications occurred during the follow‐up period. Conclusions Based on our study, USgHIFU ablation is a safe and effective method for treating AWE. Tweetable abstract As a non‐invasive treatment technique, HIFU could be used to treat abdominal wall endometriosis.

USgHIFU can safely be used to treat patients with adenomyosis and significantly improved the quality of life of patients after treatment. The cost of USgHIFU is less than that of surgical treatment.