Abdominal wall endometriosis: A challenging iatrogenic disease

Abstract

Introduction and importance Abdominal wall endometriosis is a rare clinical condition associated with abdominal pain and psychologic disorders. It's pathophysiology remains unclear. Clinical history and imaging findings are necessary for the diagnosis. Its management is challenging, and requires close collaboration between gynaecologists and visceral surgeons specially in complex procedures. The aims of our study are to present risk factors, clinical presentation, imaging findings and management features. It was a retrospective descriptive study including fifteen patients presenting abdominal wall endometriosis. Data about age, medical history, imaging findings, surgical procedures and outcome are reported. Cases presentation Fifteen women were included in our study. The most common symptom was cyclic abdominal pain. Twelve of them had history of caesarean section, and three had history of myomectomy. All patients underwent ultrasound and MRI. We performed surgical excision to all cases. One patient needed large excision with abdominoplasty procedure. Clinical discussion Abdominal wall endometriosis is a rare clinical condition with unclear pathophysiology. It occurs frequently after gynaecologic or obstetric surgery. Most reported complaint was catamenial abdominal pain with abdominal wall mass. Ultrasonography, computed tomography and MRI are useful for diagnosis, specially to eliminate differential diagnoses. Abdominal wall endometriosis management is based on surgery. Excision goals are to remove the mass and to confirm histological diagnosis of parietal endometriosis. Conclusion Parietal endometriosis is a rare and challenging condition with unclear pathophysiology. It requires specific management. This pathology will be encountered more frequently considering the increasing rate of caesarean section.

Endometriosis in Patients Undergoing Plastic Surgical Procedures: A Case Report and Review of the Literature

“…Diagnosis of abdominal wall lesions is difficult and often delayed because it usually does not present with the classic symptoms of endometriosis. 8 In a case control study of 25 patients with abdominal wall endometriosis, Ferjaoui et al 22 found that the only common symptom in all patients was cyclic pelvic pain. Marras et al 23 concluded the same in an 11-year retrospective study of endometriosis patients with involvement of the abdominal wall, highlighting the nonspecific nature of symptoms in this disease.…”

Parietal endometriosis: a real surgical endometriosis: case report

“…Ultrasound and MRI are two accessible and reliable imaging tests, visualizing the parietal heterogeneous mass [3]. The intraoperative specific aspect of endometrioma is characterized by the abundant, firm fibrosis that invades the adjacent structures, without a clear limit, usually with the presence of sites containing brown liquid, representing a source of irritation that triggers the strong local inflammatory reactions, marked by fibrosis, with a cyclical evolution [7].…”

“…Parietal Endometriosis(PE) is one of the rarest pathological feature of endometriosis [1], which mostly affects women of reproductive age, caused by the presence of ectopic islets of endometrial active cells on the abdominal wall, after surgical or gynecological procedures [2]. Its physiopathology remains under debate till this date [3].…”

“…The diagnosis can be tricky because it may be confused with stitch granuloma, hematoma, hernia or even cancer [2] so, the patient may be seen by a gynecologist, an endocrinologist, a general surgeon, an imaging specialist, or even an oncologist. [3] the histological exam is the main tool to confirm the diagnosis [4].…”

A Classical Case of Cesarean Scar Endometriosis in a 35-Year-Old Woman Presenting with Cyclical Abdominal Pain: A Case Report

“…Imaging modalities to aid in the diagnosis of scar endometriosis include magnetic resonance imaging (MRI), ultrasonography (US), and computed tomography (CT), with US generally being the initial imaging modality of choice given its cost and availability. The lesions appear to be hypoechoic and heterogenous with echogenic spots [ 24 ]. Scar endometriomas on CT appear as well-circumscribed, enhancing, solid, soft-tissue masses when intravenous contrast is used [ 25 ].…”