Extrapelvic endometriosis located individually in the rectus abdominis muscle: a rare cause of chronic pelvic pain (a case report)

Endometriosis involves the growth of endometrial-like tissue outside the uterine cavity, with its manifestation in the rectus abdominis muscle being exceptionally rare and primarily observed in women with a history of abdominal surgeries. In this report, we present the case of a 42-year-old female with a medical history of two cesarean sections who presented with cyclical abdominal pain and a palpable mass in the right lower quadrant. An MRI scan of the pelvis revealed a lesion on the right lower quadrant of the abdominal wall, proximate to the previous Pfannenstiel incision. A percutaneous US-guided biopsy of the abdominal lesion was performed, and histopathology demonstrated the presence of endometrial glands and stroma, confirming the diagnosis of rectus abdominis endometriosis. She was submitted to a local wide excision with adequate margins of normal surrounding tissue and has remained free of recurrence for two years.

Section: Discussionmentioning

confidence: 99%

Rectus Abdominis Endometriosis Following Cesarean Section: A Case Report

Kalfoutzou,

Restemi,

Mylonakis

et al. 2024

“…Abdominal wall endometriosis, characterized by the presence of ectopic endometrial glands or stroma within the abdominal wall, is a rare form of extrapelvic endometriosis [ 7 ]. Ectopic endometriotic tissue typically resides in the subcutaneous tissue, occasionally extending deep to the muscle fascia within the rectus abdominis muscles [ 8 ]. The precise incidence of abdominal wall endometriosis following cesarean section and other gynecological surgeries cannot be accurately determined.…”

Section: Introductionmentioning

confidence: 99%

Abdominal Wall Endometriosis: Early Diagnosis of a Rare Iatrogenic Complication Following Cesarean Section

Thanasa,

Antoniou

et al. 2024

Self Cite

Abdominal wall endometriosis is a rare form of extrapelvic endometriosis, frequently diagnosed with delay in most cases. It is typically iatrogenic and primarily associated with procedures such as cesarean sections or other gynecological surgeries. In our patient, endometriosis at the laparotomy scar was diagnosed relatively early, approximately two months after the onset of symptoms, which manifested 10 months after the last cesarean section. The patient, who had an obstetric history of three cesarean sections, presented at the Gynecology outpatient clinic of the General Hospital of Trikala, complaining of pain associated with menstruation located in the lower abdomen, near the surgical scar. Based on clinical and imaging findings, abdominal wall endometriosis was suspected, leading to a decision for wide excision of the endometriotic lesion. Histological examination of the surgical specimen confirmed the diagnosis. The postoperative course was uneventful, and three months after the surgery, the patient reported complete resolution of symptoms. This case report emphasizes the importance of integrating advanced diagnostic methods alongside classic clinical findings for the accurate diagnosis of abdominal wall endometriosis. It also highlights the contribution of surgical treatment through wide excision of the endometriotic lesion, in facilitating early diagnosis, achieving cure, and minimizing the risk of disease recurrence in the future.

Surgical Treatment of a Rare Case of Extrapelvic Endometriosis in the Rectus Abdominis Muscles With Negative Imaging Findings: A Case Report and Mini Literature Review

Thanasa,

Kamaretsos

et al. 2024

Abdominal wall endometriosis is an uncommon clinical entity. The localization of the disease in the muscles of the abdominal wall is considered extremely rare. Our patient with two cesarean sections in her obstetric history presented to the gynecology outpatient clinic of the General Hospital of Trikala, Trikala, Greece, complaining of intense pain, particularly during menstruation, though no palpable lesions were found in the abdominal wall. The pelvic imaging revealed no abnormalities. Based on the clinical findings, endometriosis of the abdominal wall was suspected. Surgical excision of a flat lesion from the abdominal wall muscles, followed by histological examination of the surgical specimen, confirmed endometriosis of the rectus abdominis muscle. The patient's postoperative course was smooth. Six months after surgery, without additional hormonal suppressive medication, the patient reported complete relief of symptoms. To date, she is regularly followed up at the Gynecology outpatient clinic. The remarkable feature of this case is the surgical treatment of endometriosis in the rectus abdominis muscles, based on the typical clinical findings of the disease. The case emphasizes the rarity of endometriosis in the rectus abdominis muscle, the significant challenges in preoperative diagnosis, and the crucial role of recognizing typical clinical features for early diagnosis and effective treatment of abdominal wall endometriosis.