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Abdominal Wall Endometriosis

Endometriosis is a common gynaecological condition that sometimes presents to general surgeons as a lump in the abdomen. It can pose a diagnostic dilemma and should be in the differential diagnosis of lumps in the abdomen in females. Diagnosis is usually made on histology. We discuss a case of recurrent abdominal wall endometriosis following caesarian section. The incidence, pathophysiology, course, diagnosis, treatment and prevention of this condition are also reviewed. Case Report Case 1 A 42 year old lady presented with a painful nodule on the lateral aspect of a pfannensteil incision two years after a caesarean section. . | Abdominal Wall Endometriosis Endometriosis is a common gynaecological condition that sometimes presents to general surgeons as a lump in the abdomen. It can pose a diagnostic dilemma and should be in the differential diagnosis of lumps in the abdomen in females. Diagnosis is usually made on histology. We discuss a case of recurrent abdominal wall endometriosis following caesarian section. The incidence pathophysiology course diagnosis treatment and prevention of this condition are also reviewed. Case Report Case 1 A 42 year old lady presented with a painful nodule on the lateral aspect of a pfannensteil incision two years after a caesarean section. This was initially thought to be a stitch granuloma. Two years following that she underwent abdominal hysterectomy for adenomyosis through the same abdominal incision. Following hysterectomy the abdominal wall nodule persisted and gradually enlarged in size. At presentation there was a 2.5 cm firm discolored lump in the abdominal wall at right iliac fossa fixed to underlying abdominal wall muscles and skin at the lateral aspect of the pfannensteil incision. A wide local excision was performed. The abdominal wall nodule was extraperitoneal. The adherent skin subcutaneous fat fascia and external oblique muscle were excised with a clear margin 1cm . The wound was closed primarily. The post operative recovery was uneventful and the patient remained disease free at 12 months after surgery. Pathological examination confirmed that it was endometriosis and the margins of excision were free of disease. She was given Danazol 100 mg twice daily for initial six months. Case 2 A 32-year-old woman presented to the surgery clinic with the complaint of pain and swelling on the upper part of cesarean scar for the last 2 years. She had previously had two cesarean deliveries 8 and 3 years ago. Examination revealed 2 x 2 cm mass at the upper part of cesarean scar. Fine needle aspiration cytology FNAC of the mass Figure - 1 showed .