Abdominal wall endometriosis: a diagnostic dilemma for surgeons

To report 3 cases of endometriosis of the abdominal wall, a disease which is unfamiliar to general surgeons because of the potential pitfalls in its diagnosis.

Three patients were referred to our general surgery clinic for abdominal masses. Incisional hernia and an abdominal mass were initially suspected in 2 patients, while a preoperative diagnosis of a rectus abdominis hematoma was made in the third because she had no history of previous surgery. Pain was a remarkable complaint in only one of the present cases. Abdominal wall endometriosis was diagnosed only upon histological examination postoperatively. In all cases, ultrasonography revealed hypoechogenic masses, and computed tomography showed that these masses had spiculations, and macroscopic views of the resected masses revealed well-demarcated margins without peritoneal involvement. All patients were treated with wide radical resections followed by polytetrafluoroethylene patch grafting. They were discharged from hospital on either the 2nd or the 3rd postoperative day uneventfully, and during follow-up there were no signs of pelvic endometriosis, as confirmed by ultrasonography, CA 125 measurement, gynecological consultation and examination.

Since the diagnosis of scar endometrioma is rarely established prior to surgery, endometriosis should be included in the differential diagnosis of masses on the abdominal wall.