Abdominal wall endometrioma far from previous scar
Endometriosis is defined by the presence of ectopic endometrial tissue that can respond to ovarian hormonal stimulation. Abdominal wall endometrioma prevalence is about 0.1-1%, the diagnosis can represent a challenge for the surgeon.
We present the case of a 28-year-old woman with a personal history of cesarean delivery 7 years ago who consulted due to pain relating to a mass in her right lateral abdominal wall. Physical examination showed a 2 cm nodular mass at the right lower quadrant, 10 cm away from the Pfannenstiel scar. Palpation was painful and no protrusion was felt after Valsalva or during bipedestation. Ultrasound and CT scan showed a 17 mm nodular mass at the union of oblique muscles and rectus abdominis muscle. With these findings we performed surgery to remove the mass and the specimen analysis confirmed endometrioma.
In our case the seed of this endometrioma probably took place during the previous surgery. Despite the fact that there was apparently no relation with the skin scar, it seems that it could have been sown during the dissection of the abdominal wall while gaining access to the uterus.
Differential diagnosis should be made with lymphatic node and granuloma. Surgery with free margins (more than 1 cm) is the definitive treatment. If needed, synthetic mesh placement can be indicated.
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