ePoster #5 | Clinical Science | General Surgery

Tyler Davis DO, Lutfi Barghuthi MD, Paige Moudy MS, Mohamed Abdelgawad MD, Hishaam Ismael MD

Presenter: Tyler Davis, DO, The University of Texas Health Science Center at Tyler

Introduction/Objective: Endometriosis is classically defined as “the presence of endometrial glands and stroma outside of the uterine cavity and musculature.” Although it most commonly occurs in the pelvis, various extrapelvic locations have been reported in the literature. There seems to be a strong association between abdominal wall endometriomas and previous surgical scars. Although these rare endometriomas commonly present with cyclic menstrual pain, they are often misdiagnosed with only 20-50% of cases diagnosed pre-operatively.

Case Presentation: This paper presents a 39-year-old female with an extensive gynecologic surgical history presenting with a 6 x 6 cm cyclically tender abdominal wall mass in the right lower quadrant. CT scan of the abdomen and pelvis with contrast revealed a high-density soft tissue opacity in the subcutaneous tissue of the right lower quadrant abutting the anterior aspect of the abdominal wall with associated moderate surrounding subcutaneous soft tissue stranding. The patient underwent wide local excision and pathology revealed fibroadipose tissue with interspaced endometrial glands and stroma, consistent with endometriosis. No endometriosis was identified at the margins. Post-operatively, the patient had complete resolution of her symptoms.

Discussion: Endometriosis, particularly the extrapelvic variety, has proven to be very difficult to diagnose and is often overlooked in the world of general surgery. It is theorized that these endometriomas occur by endometrial cells escaping through incisions in the uterus and implanting themselves within abdominal wall incision sites. Literature review of 39 cases from 1999-2020 revealed 79.5% of patients complained of cyclic pain, 94.9% of which had prior gynecologic surgery. Three of the patients were initially trialed with medical management, but ultimately, every patient in the literature review underwent definitive surgical treatment. Thus, it appears the best treatment of this rare disease is wide local excision.

Conclusion: In female patients presenting with a cyclically painful abdominal wall mass, a high index of suspicion for endometrioma must be maintained, especially in the setting of previous gynecologic surgery. Although there may be a role for medical management of symptoms, the most definitive treatment of an abdominal wall endometrioma appears to be wide local excision with negative margins

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