Abdominal wall endometriosis: An 11-year retrospective observational cohort study

Abstract

ObjectiveThe objective of this study was to review the records of patients with excised abdominal wall endometriosis (AWE) to determine patient characteristics, diagnostic methods, presence of concurrent pelvic endometriosis and type of surgery.Study designMedical records from an 11-year period were searched to identify histologically confirmed AWE cases. Descriptive data were collected and analyzed. Two subgroups were differentiated: isolated AWE and pelvic endometriosis-associated AWE.ResultsThirty-five women with AWE were included. The most common symptom was cyclic abdominal or parietal pain (68.6%); 17.1% of the women had no symptoms. Twenty-nine women (82.8%) had a history of gynecological or obstetrical surgery, most commonly cesarean section (CS). The mean interval between prior surgery and appearance of symptoms was 5.3 years. Six women (17.1%) had no prior surgery; all six presented with umbilical nodules, nulliparity and confirmed mild to severe pelvic endometriosis. Among all patients, 34.3% had concurrent pelvic endometriosis, 40% presented with isolated AWE and 25.7% had no pelvic exploration. Women with concurrent pelvic endometriosis had significantly lower parity, smaller nodule size and a higher likelihood of umbilical location than those with isolated AWE (p < 0.05). A history of CS was more commonly found in women with isolated AWE. The overall recurrence rate over the study period was 11.4%, with a mean follow-up period of 5.2 years.ConclusionsAWE is an uncommon condition associated with long diagnostic and therapeutic delays. In patients with umbilical AWE and no surgical history, pelvic endometriosis is commonly present and should be highly suspected.

Clinico-pathological assessment of surgically removed abdominal wall endometriomas following cesarean section

“…But the AWE condition following CS has an estimated incidence of 0.07%–0.47% [ 23 ]. Our percent is consistent with Marras et al reporting an estimated incidence of AWE after CS was 0.23% [ 24 ].…”

Extra‐pelvic endometriosis: A review

“…The postoperative recurrence rate of AWE is 4.5%‐11.2%, 11,23,27 lower than that of ovarian endometriosis. To date, there has been no report demonstrating that hormonal therapy is effective for AWE 22 .…”

“…Imaging tests such as CT and MRI are useful to determine the extent of the lesion before surgery. 22 The postoperative recurrence rate of AWE is 4.5%-11.2%, 11,23,27 lower than that of ovarian endometriosis. To date, there has been no report demonstrating that hormonal therapy is effective for AWE.…”

“…MRI and CT are helpful for clarifying the extent of the lesion, fascia involvement, and the depth of lesion invasion. [21][22][23] On MRI, the presence of blood components within the abdominal wall mass is suggestive of endometriosis. 21,24 Fine-needle aspiration can confirm the preoperative diagnosis of AWE, excluding malignancy.…”

“…Ultrasonography is a simple procedure, which often shows AWE as a low‐echo solid mass. MRI and CT are helpful for clarifying the extent of the lesion, fascia involvement, and the depth of lesion invasion 21‐23 . On MRI, the presence of blood components within the abdominal wall mass is suggestive of endometriosis 21,24 .…”