Abstract
Background: Endometrial cell implantation after abdominal surgery, mainly after caesarean section, may result in formation of endometrioma, which is usually described to be of various sizes, and adjacent to the surgical scar. Case: A 36-year old woman complaining of a mass of the abdominal wall with pain during the menstrual period, with a caesarean section 5 years earlier, presented a rounded tumour not contiguous to the Pfannenstiel’s laparotomy scar, of hard consistence, fixed and adherent to the deep abdominal wall structures, located on the left paramedian epigastric region. Magnetic Resonance imaging showed the nodule, involving the deep layers of the abdominal wall and the distance from the laparotomic scar. Surgical removal was performed with wide excision of the lesion, causing a large wall defect. After histological confirmation (endometriosis) by frozen section, reconstruction of the abdominal wall required prolene mesh grafting. After twelve months the patient is healthy. Conclusion: When abdominal wall endometrioma is located distant from the scar, perhaps more frequently after Pfannenstiel’s laparotomic incision, the differential diagnosis may be more difficult and MRI can help differentiating many of these lesions, and histological confirmation should be obtained intraoperatively, by frozen section, to allow an oncological resection if required.
Highlights
Case: A 36-year old woman complaining of a mass of the abdominal wall with pain during the menstrual period, with a caesarean section 5 years earlier, presented a rounded tumour not contiguous to the Pfannenstiel’s laparotomy scar, of hard consistence, fixed and adherent to the deep abdominal wall structures, located on the left paramedian epigastric region
When abdominal wall endometrioma is located distant from the scar, perhaps more frequently after Pfannenstiel’s laparotomic incision, the differential diagnosis may be more difficult and Magnetic resonance imaging (MRI) can help differentiating many of these lesions, and histological confirmation should be obtained intraoperatively, by frozen section, to allow an oncological resection if required
The caesarean section scar presented in good condition and the mass was not contiguous to the Pfannenstiel’s laparotomy scar, located on the left paramedian epigastric region, a few centimetre above the scar, rounded, and about 5 cm of diameter, of hard consistence, fixed and adherent to the deep abdominal wall structures
Summary
An unusual presentation of a large abdominal wall endometrioma, located at some distances from the scar of the previous caesarean section, is reported, and diagnostic and therapeutic approach is described
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