Post-caesarean Section Cicatricial Parietal Endometriosis: Case Report and Review of the Literature at the Brazzaville University Hospital (Republic of Congo)

Abstract

Introduction: Defined as the implantation of endometrial tissue within parietal abdominal structures more superficial than the peritoneum, parietal endometriosis is an exceptional localization of extragenital endometriosis, most often secondary to gynecological obstetric surgery. Clinical observation: We report the case of a 32-year-old patient presenting with an abdominal parietal pain syndrome in comparison with a post-caesarean cutaneous cicatrix, cyclic and rhythmic by menstruation. Ultrasonography of the soft tissues revealed two anterior, heterogeneous hypoechoic nodules with posterior reinforcement. A wide surgery with 1cm of healthy margin allowed the excision of the nodule interesting the subcutaneous tissue and the aponeurosis of the rectus abdominis muscle. The histology was in favour of a focal endometriosis of the abdominal wall extended to the fascia of the rectus muscle. Microscopic examination revealed endometrial glands of variable size, sometimes dilated, bordered by regular cylindrical epithelium, associated with a cytogenic chorion and lymphocytic inflammation, sometimes with blood. Immediate postoperative outcomes were simple. An LHRH analogue protocol (Leuprolide acetate 3.75 mg in one intramuscular injection every 28 days for 6 months) was instituted. Conclusion: Although exceptional, it is appropriate to think of an endometriosis before an abdominal pain syndrome abdominal wall of the woman during periods of genital activity.