An Approach to Abdominal-Wall Endometriosis: A Retrospective Case Series

Objective: This article offers insight into an academic institute's approach to the rare phenomenon of abdominal-wall endometriosis (AWE). The article also provides data on concurrent pelvic endometriosis, which has not often been assessed in previous studies. The aim here is to describe the characteristics and management of AWE at an academic institute. Materials and Methods: A retrospective chart review was conducted on 28 patients with pathologically confirmed AWE at an academic institute. Results: The most commonly reported symptoms were constant pain (19/28; 67.9%), cyclic pain (16/28; 57.1%), and palpable mass (16/28; 57.1%). All patients reported having had prior abdominal surgery. Preoperative imaging included 14 magnetic resonance imaging scans, 11 computed tomography scans, and 8 ultrasounds. Nine general surgery and 19 anesthesiology preoperative consultations occurred. AWE was found within 5 cm of a previous incision in 24 of 28 patients; these were 20 cesarean-section and 4 laparoscopic incisions. The average size of the lesions was 3.8 cm. Four patients required mesh and 26 patients underwent concurrent laparoscopy at the time of excision. Endometriosis and/or adenomyosis was noted in 25 patients (96.2%). Fifteen patients underwent regional anesthetic blocking. The average length of stay for these patients was 1158.3 versus 1705.7 minutes for those who did not. Conclusions: Pain and a mass at a previous surgical site warrants a workup for AWE. If AWE is suspected, one should consider laparoscopy for any patient with symptoms suggestive of pelvic endometriosis. Perioperative, regional anesthetic blocks should be also considered.