Sonographic Findings of Abdominal Wall Endometriosis in Persistent Abdominal Wall Pain: A Case Report

Abstract

Introduction/Background: Endometriosis is considered a chronic neuroinflammatory disease of debilitating pain, most often in the pelvic area. In rare cases, endometriosis can develop through iatrogenic implantation of endometrial cells/fragments into a scar area during the cesarean delivery. Case Description: A case of a 32-year-old female patient who underwent physical therapy for abdominal muscle pain with occasional irradiation of pain to the sacral region is presented. The pain developed soon after a cesarean delivery, which was performed 3 years ago. Outcomes: Palpation performed at the initial examination and after removal of the lesions showed a significant reduction in tone at the site of the lesions and a reduction in palpation pain. The objective primary tools and specific outcome measures used in this case were musculoskeletal sonography and a patient questionnaire (36-Item Short Form Health Survey [SF-36]). Abdominal wall lesions were found to be 34 × 13 × 40 mm and 30 × 15 × 22 mm in size and were surgically removed by a specialized surgeon with histological confirmation of endometriosis. The SF-36 scores considerably improved in all domains following removal of the lesions compared with the condition at the initial examination. Discussion: The presented case is an example of the musculoskeletal sonography evaluation following palpation of the abdominal wall in women after a cesarean delivery. The described sonographic examination performed by a physical therapist can be part of a comprehensive assessment of scar healing, diastasis, and the ability to activate the abdominal muscles during postpartum rehabilitation. Informed Consent: The patient signed informed consent, in which she agreed to the anonymous publication of her case. A supplemental video abstract available at: https://www.youtube.com/watch?v=Vd87WB8ZQd0&t=16s