Abdominal Wall Endometriosis: Two Case Reports and Literature Review

Percutaneous cryoablation of abdominal wall endometriosis: a systematic literature review of safety and efficacy

PURPOSE

To investigate over 10 years the safety and efficacy of percutaneous cryoablation for the treatment of abdominal wall endometriosis (AWE).

METHODS

A systematic review was conducted of literature published between March 2014 and March 2024. Inclusion criteria focused on treatment efficacy studies, while exclusion criteria targeted case reports and studies lacking pertinent outcome data. Methodological quality was assessed using the Newcastle-Ottawa Scale for cohort studies.

RESULTS

A total of eight studies were included. Local pain scores decreased from a median of 8/10 (interquartile range (IQR) 7-9) on the visual analog scale to 1/10 (IQR 0-2) at the last follow-up (p < 0.0001). Median complete local pain response rates ranged from 80% to 100%, with median local pain-free survival rates reaching 76.8% (IQR 55.3-83.8) at the longest follow-up. Notably, no patient reported a post-procedure pain score higher than that they reported pre-cryoablation. The studies indicated minor complications in 3.5 to 11% of cases, with major complications occurring in less than 2% of cases, graded following the guidelines of the Society of Interventional Radiology.

CONCLUSION

In the last decade, percutaneous image-guided cryoablation has offered consistent results and appears to be a promising, minimally invasive option for AWE treatment. Prospective trials are now essential to establish cryoablation as a new standard in patient care for AWE.

CRITICAL RELEVANCE STATEMENT

Over a decade-long study, percutaneous cryoablation has proven to be a safe and effective minimally invasive treatment for abdominal wall endometriosis, significantly reducing pain with minimal complications.

KEY POINTS

Percutaneous cryoablation significantly reduced local pain scores for abdominal wall endometriosis. The procedure demonstrated a favorable safety profile with minor complications. Cryoablation has emerged as a minimally invasive alternative to traditional treatments.

Parietal endometriosis: An uncommon cause of c-section scar pain - A case report

INTRODUCTION

Parietal endometriosis is the most common form of extra-pelvic endometriosis. It develops on the surgical scar of c-section or hysterectomy. It is one of the causes of scar pain.

CASE PRESENTATION

A 26 years old patient presents with recurring pain and swelling of a Pfannenstiel scar 6 years after a caesarean section. Physical examination revealed a firm tender subcutaneous nodule that appeared at MRI as a heterogenous parietal mass infiltrating the rectus abdominis muscles. The patient underwent a wide excision of the nodule.

DISCUSSION

Parietal endometriosis can be the cause of debilitating scar pain even in patients with no history of deep endometriosis. It presents as firm parietal nodule that can become large and infiltrative if left untreated. Diagnosis is purely histological. Surgery remains the treatment of choice and requires a wide excision.

CONCLUSION

Parietal endometriosis, potentially more common due to rising number of caesarean sections, should be considered with persistent scar pain. Surgery is the preferred treatment, offering a conclusive diagnosis.

Abdominal Wall Endometriosis at the Cesarean Section Scar

Abdominal wall endometriosis is atypical localization of the extra-pelvic endometriosis with non-specific symptoms and is difficult for diagnosis. Cesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis, which usually develops after obstetric operations. We report a case of a 33-year-old woman who had two previous cesarean sections presented with a mass in the subcutaneous tissue of the abdominal wall, approximately 4 cm superior to the Pfannenstiel incision, 5 years after her second lower segment caesarean section. The classic clinical presentation, imaging findings on ultrasonography and computed tomography are analyzed. Treatment with local surgical excision of the mass is discussed. The diagnosis was confirmed with histopathological analysis of the surgical sample. When it comes to the limited painful lesion in the subcutaneous tissue at the cesarean scar, with a pain intensifying during menstruation, the physician should consider cesarean scar endometriosis in women of reproductive age with a history of cesarean section.

Clinical and Surgical Characteristics of Abdominal Wall Endometriosis: A Multicenter Case Series of 80 Women

BACKGROUND/AIM

Endometriosis of the abdominal wall (AWE) is poorly understood because of its rarity and heterogeneous nature. The aim of this study was to investigate and present the clinical and surgical characteristics of AWE and to propose its classification.

PATIENTS AND METHODS

This was a multicentric retrospective study. For this analysis, the data from three endometriosis centers were collected. In total 80 patients were included in this study. The Academic Hospital Cologne Weyertal is a certified, level III endometriosis center in Germany with 750-1,000 endometriosis surgeries being performed annually; Barzilai University Medical Center is a certified endometriosis center in Ashkelon, Israel; and Baku Health Center is an endometriosis Center in Baku, Azerbaijan.

RESULTS

The size of nodule (histological specimen) was significant larger in women with than those without adenomyosis (3.34±1.4 vs. 2.55±1.33 cm, p=0.016). The incidence of subfascial involvement was also found to be significantly higher in these women (42% vs. 19%, p=0.03). No significant difference was found in patients with and without obesity. In 78% of cases, the proliferation level (Ki67 marker) was less than 30%.

CONCLUSION

AWE has a high prevalence of symptoms such as abdominal wall pain and swelling, as well as bleeding. The strengths of the current study are the investigation of the proliferation marker Ki67 in AWE, the impact of adenomyosis, as well as the suggested classification.

Abdominal wall endometriosis: a case report

Abdominal wall endometriosis is the development of endometrial tissue in the anterior abdomen usually due to an operation in which the uterus is manipulated. We herein delineate the presentation, clinical investigation, and surgical treatment of an abdominal wall endometriosis case. A 42-year-old female presented with acute abdominal pain in the lower quadrants in the margins of an old cesarean scar. Two masses in the abdominal wall highly suspected of consisting of endometrial tissue were found during the investigation of the patient. These ones were removed in surgery and endometrial tissue secondary to previous cesarean section was confirmed after histological analysis. Consequently, although rare, if a painful mass in a surgical scar, such as a Pfannenstiel incision, is found in women of reproductive age with a history of obstetric surgery, the differential diagnosis shall include endometriosis. There is a portion of cases in which endometriosis recurs within five years following conservative surgery.

Abdominal wall endometriosis: Report of 83 cases

OBJECTIVE

To investigate the clinical course and management of abdominal wall endometriosis (AWE).

METHODS

A retrospective study was carried out from January 2010 to December 2020, at Vita-Nações Hospitals, Curitiba, Brazil, in order to evaluate data of patients undergoing surgery for the excision of AWE.

RESULTS

83 women with AWE were included in the study. Umbilical scar endometriosis was found in 26 patients (31.3%), being primary in 20 cases (76.9%) and secondary to a laparoscopic procedure in 6 cases (23.1%). 2 patients had secondary implants outside the umbilicus after laparoscopic surgery. Secondary implant after cesarian section in 55 patients (66.3%). Diagnosis was made by ultrasound in 65 patients (78.3%) and by MRI in the remaining 18 (21.7%). Complete excision of the nodule was carried out and no case of recurrence was registered up to now.

CONCLUSIONS

Painful abdominal mass presenting in women, especially with a previous history of abdominal and pelvic surgery, should be suspected of AWE. It occurs most often secondary to obstetric or gynecological surgeries and seems to be related to iatrogenic transfer of the endometrial tissue at the level of the surgical scar. Cesarean scar endometriosis is the most common presentation. Surgical excision including the surrounding fibrotic tissue should be performed.