Multidisciplinary treatment of abdominal wall endometriosis: A case report and literature review

A 31-year-old female patient presented with complaints of cyclic low abdominal wall pain and palpable abdominal mass for more than 4 years. Physical examination revealed a painful mass measuring 7 cm × 5 cm within the abdominal wall. Her surgical history included surgery for congenital lymphatic haemangioma twice and caesarean section delivery twice. Results of abdominal wall ultrasonography, magnetic resonance imaging, and enhanced computed tomography revealed a soft tissue mass within the abdominal wall, indicating abdominal wall endometriosis. Pathologic examination with fine-needle aspiration of the abdominal wall mass showed endometrial glands and stroma. A multidisciplinary treatment team was established at admission, and surgical excision of the abdominal wall endometriosis mass was recommended. Surgery was performed by our multidisciplinary treatment team. Intraoperatively, the abdominal wall muscle, symphysis pubis, and anterior bladder wall were found to be infiltrated by abdominal wall endometriosis tissue. The abdominal wall endometriosis mass was completely resected with part of the bladder wall, symphysis pubis periosteum, and abdominal wall muscle and fascia (measuring 9 cm × 8 cm × 6 cm). The abdominal wall defect could not be sutured in a routine manner; thus, autologous reconstruction of the abdominal wall defect with left anterolateral thigh musculocutaneous flap was performed. The patient recovered without complications, and follow-up was uneventful. The successful treatment in our case suggests that adequate preoperative examinations and multidisciplinary treatment team collaboration are crucial to the treatment of patients with large abdominal wall endometriosis mass. Anterolateral thigh musculocutaneous flap reconstruction may serve as an optional treatment for abdominal wall defects during surgical excision of abdominal wall endometriosis mass.