Abdominal Wall Endometrioma after Cesarean

Background: Endometriosis is defined as the presence of endometrial tissue, glands or stroma, outside the endometrial uterine area. Ectopic tissue has been reported in extrapelvic locations such as the brain, soft tissues, and even the thorax. The incidence after a cesarean section is 0.03-0.45%. Abdominal wall endometrioma usually presents in patients as a tumor close to the surgical scar that causes colicky pain, dyspareunia, dysmenorrhea. As treatment, complete excision with margins is recommended.

Study Design: Case Report.

Case Presentation: A 45-year-old female patient found in the emergency room due to intense abdominal pain, which is increased with menstruation. This pain has been going on for the last 5 years. An abdominal tomography was made, finding an image towards the rectus abdominis. It was decided to schedule surgery, the tissue was sent to pathology to confirm the diagnosis. The pathology report concluded endometrioma of the abdominal wall.

Discussion: Since 1860 when it was first described, about 40 years have passed before soft tissue endometrioma was described for the first time, this condition has a low incidence, causing it to be underdiagnosed, the diagnosis is usually late with a large evolution between onset of symptoms and diagnosis due to lack of suspicion and low knowledge on the subject, the multiple differential diagnoses such as abdominal wall hematoma, granuloma, desmoid tumor makes it difficult to diagnose, as an example our patient was treated as an hematoma and later attributed to pain of psychological origin. The diagnostic triad includes cramping pain related with menstruation, history of gynecological surgery and tumor near the scar, all present in our case. Surgical treatment has been described as the gold standard, performing an excisional biopsy with free margins to avoid recurrence, as it was done in this case.

Conclusion: Endometrioma is a rare condition, with a wide variety of differential diagnosis causing a late diagnosis. Expertise is required when making differential diagnoses. It is important to refer to a gynecologist after diagnosis to assess concomitant endometriosis.