Abstract
Objectives A 46-year-old woman with previous caesarean sections presented with painful left lower quadrant mass and also had new onset of heavy and painful periods for eighteen months that was previously well controlled with the intrauterine device. On exam she had tender hard 4cm left sided lower abdominal mass above her caesarean scar. Magnetic resonance imaging revealed spiculated enhancing mass in the left rectus abdominus muscle 2.3 × 3.1 × 2.9cm and there was tethering of the anterior body of the uterus to this mass, findings representing scar endometriosis and adenomyosis of the uterus. She successfully underwent open total abdominal hysterectomy with en-bloc surgical excision of the abdominal wall endometriosis (AWE) (excised soft tissue mass 11 × 7 × 4.5cm) and mesh repair of the large anterior abdominal wall defect. Histology confirmed AWE and adenomyosis of the uterus and good histological margin. Consent to publish was obtained from patient. Methods Case report Results Case report Conclusions Abdominal wall endometriosis (AWE) is rare with an estimated prevalence of 1.34% in patients undergoing surgery for pelvic endometriosis. Abdominal surgery particularly caesarean section is a major risk factor for its development typically near the caesarean scar. Surgical excision is considered the criterion standard for treatment of AWE with at least 1cm margin on all sides of the endometriosis being optimal. We present a unique case where we had to perform en-bloc surgical excision of the anterior AWE with hysterectomy of the attached uterus as a joint surgical procedure with general surgeon and mesh closure of the abdominal wall defect.
Published Version
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