Total Surgical Excision by Ultrasound–Guided Wire Localization for Spontaneous Abdominal-Wall Endometriosis

Abstract

Background:

Extrapelvic endometriosis is the most-common form of abdominal-wall endometriosis (AWE). This rare condition usually results from transport of endometrial tissue into incision sites of surgical operations or adjacent tissues. Spontaneous AWE also occurs. A common symptom is a painful and tender mass usually associated with menstruation. Noncyclic pain can occur in 45% of patients. Standard treatment is complete surgical excision.

Case:

This 44-four-year-old patient, gravida 0, presented with persistent cyclic pain in her right inguinal area, but she had no history of previous abdominal surgery Ultrasonography (USG) showed an obscure, heterogeneous–hypoechogenic mass of ∼2.0 × 1.5 cm in the right lower quadrant of her abdominal wall. She underwent total surgical excision by ultrasound–guided-wire localization.

Results:

The nonpalpable mass that was localized via an ultrasound-guided wire was surgically excised. A diagnosis of AWE was confirmed by histopathologic examination of the mass. Two months postoperatively, this patient's pain disappeared.

Conclusions:

Extrapelvic endometriosis can be located in almost any organ of the body, including the abdominal wall. The incidence of AWE is reported to be up to 0.03%–3.5%, and most cases of AWE commonly arise in an incision made during a cesarean section. Spontaneous AWE is less common, compared to cesarean-scar endometriosis. The diagnosis of AWE is difficult due to its rarity, subclinical presentation, and generally nonpalpable lesions. Ultrasound–guided-wire localization is a reliable, simple, and practical solution for localizing nonpalpable lesions.