Bauchdeckenendometriose: Diagnostisches und therapeutisches Management

Abstract

PURPOSE: Abdominal wall endometriosis is a rare type of extragenital endometriosis. There are no large cohorts in the literature providing for evidenced-based management of such lesions. PATIENTS: We present 16 patients with endometriosis of the abdominal wall. In addition, we performed a review of the literature. RESULTS: 4 patients had primary umbilical endometriosis. 12 patients had abdominal wall endometriosis located in scar tissue after surgery (8 times after caesarean section, 4 times after laparoscopy). Diagnoses were based on history, examination, ultrasound and MRI. Therapeutic management was planned on an individual basis, depending on symptoms, the extent of the lesion, and the presence or absence of other forms of endometriosis. Local resection was performed in 3 cases and umbilical excision with umbilical reconstruction in 3 cases. In 9 cases systemic hormonal treatment was administered with effective results. The recurrence rate after complete resection was low. An association with external genital endometriosis was observed in the cases of primary umbilical endometriosis or scar endometriosis after surgery for endometriosis. In cases with scar endometriosis after caesarean section an association with external genital endometriosis was uncommon. CONCLUSION: Endometriosis of the abdominal wall is a rare type of endometriosis. Clinical management must be planned on an individual basis and must take account of other factors such as symptoms, the extent of the lesion and the presence or absence of external genital endometriosis. Operative and endocrine treatment could be effective. Knowledge of the lesion's extent is mandatory for adequate treatment planning, and an interdisciplinary approach is helpful, particularly if plastic surgery is needed.