Abdominal wall endometriosis after cesarean section

Abstract

Background : Abdominal wall endometriosis is rare and difficult to diagnose. Overall abdominal wall endometriosis incidence has been reported 0.03-1.0% of women with cesarean section scar.Case : We report the case of a 26-year-old woman with no endometriosis history. The 15×3×3 cm tumor was firm and located at a right angle from the incision of a cesarean section conducted 2 years earlier along the rectus abdominis muscle to the umbilicus level. Regardless of treatment with a gonadotropin-releasing hormone (GnRH) analog for 6 months, the woman showed ongoing, increasing symptoms fluctuating with her menses, and the lesion also gradually grew. Fine-needle aspiration cytology (FNAC) showed cellular sheets of epithelial and stromal cells against a hemorrhagic background that confirmed the presence of endometrium and excluded carcinoma. The woman was clinically diagnosed with abdominal wall endometriosis, eventually undergoing wide local excision of the lesion with negative margins. Follow-up at 18 months showed continued recovery.Conclusion : We found FNAC to be useful in preoperative diagnosis, and surgical management provides the best option for both a definitive diagnosis and effective treatment of large abdominal wall endometriosis.