An Approach to Abdominal-Wall Endometriosis: A Retrospective Case Series

Abstract

Objective: This article offers insight into an academic institute's approach to the rare phenomenon of abdominalwall endometriosis (AWE). The article also provides data on concurrent pelvic endometriosis, which has not often been assessed in previous studies. The aim here is to describe the characteristics and management of AWE at an academic institute. Materials and Methods: A retrospective chart review was conducted on 28 patients with pathologically confirmed AWE at an academic institute. Results: The most commonly reported symptoms were constant pain (19/28; 67.9%), cyclic pain (16/28; 57.1%), and palpable mass (16/28; 57.1%). All patients reported having had prior abdominal surgery. Preoperative imaging included 14 magnetic resonance imaging scans, 11 computed tomography scans, and 8 ultrasounds. Nine general surgery and 19 anesthesiology preoperative consultations occurred. AWE was found within 5 cm of a previous incision in 24 of 28 patients; these were 20 cesarean-section and 4 laparoscopic incisions. The average size of the lesions was 3.8 cm. Four patients required mesh and 26 patients underwent concurrent laparoscopy at the time of excision. Endometriosis and/or adenomyosis was noted in 25 patients (96.2%). Fifteen patients underwent regional anesthetic blocking. The average length of stay for these patients was 1158.3 versus 1705.7 minutes for those who did not. Conclusions: Pain and a mass at a previous surgical site warrants a workup for AWE. If AWE is suspected, one should consider laparoscopy for any patient with symptoms suggestive of pelvic endometriosis. Perioperative, regional anesthetic blocks should be also considered.

Abdominal wall endometriosis: an update in diagnosis, perioperative considerations and management

“…AWE has been reported in the scar tissue of laparotomies, laparoscopic port sites, and hernia repairs [1 ▪ ,3 ▪▪ ]. Most cases are associated with cesarean sections, followed by laparoscopic or abdominal gynecologic surgery [3 ▪▪ ,8 ▪ ]. The prevalence of AWE after cesarean section has been reported as 0.23–1.3% [3 ▪▪ ,7].…”

“…The frequency of concurrent pelvic endometriosis in patients with AWE varies, with reported rates between 15.4 and 92% in recent studies [1 ▪ ,3 ▪▪ ,8 ▪ ,10 ▪▪ ]. This wide range is influenced by preoperative clinical suspicion of pelvic endometriosis and route of surgery.…”

“…This wide range is influenced by preoperative clinical suspicion of pelvic endometriosis and route of surgery. Surgeons who perform laparoscopic excision of AWE routinely explore the pelvis for endometriosis even in the absence of signs or symptoms concerning for pelvic endometriosis, and therefore are more likely diagnose pelvic endometriosis [8 ▪ ,10 ▪▪ ].…”

“…Detailed radiologic mapping of disease extent is a critical component of preoperative planning. If large fascial defects are anticipated which will preclude primary fascial closure, surgical teams with experience in abdominal wall reconstruction techniques should be consulted preoperatively [8 ▪ ,11]. In cases of nonpalpable lesions with small nodules and/or patients with elevated BMI, radiology can perform needle localization on the day of surgery which greatly improves intraoperative identification [11,16].…”

“…Fine needle aspiration and core needle aspiration under ultrasound or MRI guidance have both been described as useful techniques to confirm the diagnosis of AWE and exclude malignancy prior to surgery [8 ▪ ,11]. Percutaneous biopsy is not favored by some authors, due to theoretical risk of dissemination along the path of puncture [14 ▪ ].…”