[Abdominal wall endometriosis after gynecologic procedures: an under-appreciated diagnosis in general surgery]

Incisional endometriosis is a clinical entity described in the gynecologic literature but it is not well recognized among general surgeons. The preoperative diagnosis is often mistaken for a suture granuloma, abscess, lipoma, cyst or incisional hernia.

This is a retrospective review of six cases of incisional endometriosis in our hospital aimed at determining which, if any, factors would suggest the diagnosis preoperatively. All general surgery patients with a diagnosis of endometriosis in their pathology specimens from January 1990 to February 2006 were reviewed.

All six patients had previous cesarean sections through either a Pfannenstiel (n = 4) or lower midline (n = 2) incision. Ages ranged from 28 to 43 years (mean 34.3 years). All patients presented with a palpable painful lesion located in the area of cesarean section incision. Three of the patients had a change in symptoms with their menstrual cycle. The duration of symptoms ranged between 2 months to 6 years. All patients underwent surgical excision. The size of the excised endometrioma ranged from 3 cm to 9 cm (mean 5.3 cm).

Incisional endometriosis seems to be common in women with a history of cesarean section. Most patients presented with a painful abdominal mass. Three patients presented cyclic changes in pain and size of the mass with menses, but this may be due to physician's lack of awareness and questioning. The management of choice is to remove the lesion completely even if fascial excision is required.