Anterior Abdominal Wall Scar Endometriosis: An Enigma.

Abstract

The presence of functioning endometrium outside the uterine cavity is called endometriosis. It is a major gynecological problem which affects 8–10 % of women of reproductive age. In 30 % of the women, the condition is associated with primary or secondary infertility [1]. Endometriosis is common in the pelvic organs like ovaries, pouch of Douglas, broad ligament, uterosacral ligament, fallopian tubes, rectosigmoid colon, bladder, and uterovesicle space, and also on other genital organs like episiotomy scars and bartholin glands [2]. Extra pelvic endometriosis is a rare entity occurring in the following possible sites—in the order of their frequency: the peritoneum, the abdominal wall, and bladder. Rare are the umbilicus, kidney, lungs, pleura, and the extremities. Scar endometriosis is a rare disease with an incidence of 0.03–0.15 %. They present with varied clinical manifestations like pain, painful palpable nodules, bleeding from scar, cramps, and bloating sensation during menses. Anterior abdominal wall endometrioma is well documented in the literature, but it may cause diagnostic dilemma due to unfamiliarity and rarity. This case report helps to highlight the fact that extra pelvic endometriosis still remains an enigma—difficult to diagnose clinical condition requiring high index of clinical suspicion—especially when it is recurrent and deep seated in fascia as occurred in our case.