Analysis of clinical factors in endometriosis of the abdominal wall

The abdominal wall is one of the rare sites of endometriosis, and its clinical incidence is increasing year by year with the increasing cesarean section rate nowadays.

A retrospective analysis was made on patients with abdominal wall endometriosis who attended Changzhou Second Hospital of Nanjing Medical University from January 2013 to December 2022. They were grouped by depth of infiltration of lesion and direction of incision, and the differences between the groups were compared.

A total of 228 patients aged 32.7 ± 4.2 with abdominal wall endometriosis were included in this study, including 210 cases with a history of abdominal transverse incision surgery, 16 cases with a history of vertical incision surgery, 1 case with a history of uterine fibroids surgery, and 1 case with primary abdominal endometriosis, and 178 cases with the primary symptom of cyclic pain. The patients were classified as solitary and complex ones according to the number of lesions. Both groups were statistically significant for BMI, number of caesarean sections, operation time, bleeding, and postoperative hospital stay (p < 0.05). According to the depth of infiltration, the patients were divided into fascial, rectus abdominis, and peritoneal types, with differences in latency time, CA125, maximum diameter of the lesion, operation time, bleeding, and postoperative hospital stay (p < 0.05). The direction of incision for caesarean section had no significant effect on the development of endometriosis in the abdominal wall or whether the lesions were multiple (p > 0.05). On imaging, magnetic resonance imaging was more accurate for lesion typing.

AWE should be diagnosed early and treated surgically. The clinical manifestations of the same type are different, and CA125 testing and abdominal wall ultrasound can be used preoperatively for lesion typing. Nuclear magnetic resonance (NMR) may be used to improve preoperative preparations for difficult diagnosis or typing.