Incidence, diagnosis and management of abdominal wall endometriomas: a retrospective study and literature review

Abstract

Abdominal wall endometriosis (AWE) is a rare extra pelvic manifestation of endometriosis, most commonly associated with prior cesarean section, and is frequently misdiagnosed due to nonspecific clinical features. This retrospective case study describes the presentation, diagnostic evaluation, and surgical outcomes of patients with abdominal wall and umbilical endometriosis at a single institution. Ten patients with pathologically confirmed endometriosis following surgical excision were identified. Eight cases involved the abdominal wall and two involved the umbilicus. All patients with abdominal wall lesions had a history of cesarean delivery, while neither patient with umbilical endometriosis had prior abdominal surgery. The most common presenting features were localized abdominal wall pain and a palpable mass, often with cyclical exacerbation. Magnetic resonance imaging and computed tomography were employed selectively for lesion characterization and operative planning. All patients underwent surgical excision with clear margins, resulting in significant postoperative symptom improvement and no immediate complications. Abdominal wall endometriosis should be considered in the differential diagnosis of abdominal wall masses, particularly in patients with a history of cesarean section and cyclical pain. Surgical excision remains the definitive treatment and is associated with excellent clinical outcomes.