An Abdominal Wall Endometriosis at Jimma University Medical Centre, Ethiopia: A Case Report

Abdominal wall endometriosis is a rare condition, often occurring as a complication following gynecologic surgery, especially caesarean sections. Its diagnosis is frequently delayed due to non-specific symptoms and a wide range of differential diagnoses. Case Description: We report A 25-year-old woman, para 1 by caesarean section, presented with cyclic left lower abdominal pain and swelling, worsening during menstruation. Physical examination revealed a firm, nontender mass near the caesarean scar. Imaging studies including ultrasound and color Doppler identified a hypoechoic lesion in the rectus abdominis muscle with internal vascularity. Fine needle aspiration cytology supported a diagnosis of endometriosis. Intervention and Outcome: Surgical excision under spinal anaesthesia was performed in complete removal of the lesion, with no postoperative complications. The patient remained symptom-free at six-month follow-up.

This case highlights the importance of considering abdominal wall endometriosis in women with cyclical pain and prior uterine surgery. Imaging and histopathology are key to diagnosis, while complete surgical excision remains the definitive treatment.

Gruber TM, Mechsner S. Pathogenesis of endometriosis: the origin of pain and subfertility. Cells. 2021;10(6):1381. Stochino-Loi E, Millochau J-C, Angioni S, Touleimat S, Abo C, Chanavaz-Lacheray I, et al. Relationship between patient age and disease features in a prospective cohort of 1560 women affected by endometriosis. Journal of minimally invasive gynecology. 2020;27(5):1158-66. Ng K-S, Lee PJ. Pelvic exenteration: pre-, intra-, and post-operative considerations. Surgical Oncology. 2021;37:101546. Bazot M, Daraï E. Diagnosis of deep endometriosis: clinical examination, ultrasonography, magnetic resonance imaging, and other techniques. Fertility and sterility. 2017;108(6):886-94. Machairiotis N, Stylianaki A, Dryllis G, Zarogoulidis P, Kouroutou P, Tsiamis N, et al. Extrapelvic endometriosis: a rare entity or an under diagnosed condition? Diagnostic pathology. 2013;8(1):194. Gayer G, Park C, editors. Abdominal Wall masses: CT findings and clues to differential diagnosis. Seminars in Ultrasound, CT and MRI; 2018: Elsevier. Yovich JL. Understanding endometriosis: clarifying Sampson’s theories with a personal perspective. Med J Obstet Gynecol. 2020;8(1):1130. Batt RE. Sampson’s theory of implantation endometriosis. A History of Endometriosis: Springer; 2011. p. 143-67. Pitot MA, Bookwalter CA, Dudiak KM. Müllerian duct anomalies coincident with endometriosis: a review. Abdominal Radiology. 2020;45(6):1723-40. Vinatier D, Orazi G, Cosson M, Dufour P. Theories of endometriosis. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2001;96(1):21-34. Konrad L, Dietze R, Kudipudi PK, Horné F, Meinhold-Heerlein I. Endometriosis in MRKH cases as a proof for the coelomic metaplasia hypothesis? Reproduction. 2019;158(2):R41-R7. Gylfason JT, Kristjansson KA, Sverrisdottir G, Jonsdottir K, Rafnsson V, Geirsson RT. Pelvic endometriosis diagnosed in an entire nation over 20 years. American journal of epidemiology. 2010;172(3):237-43. Dmowski WP, Lesniewicz R, Rana N, Pepping P, Noursalehi M. Changing trends in the diagnosis of endometriosis: a comparative study of women with pelvic endometriosis presenting with chronic pelvic pain or infertility. Fertility and sterility. 1997;67(2):238-43. Khan Z, Zanfagnin V, El-Nashar SA, Famuyide AO, Daftary GS, Hopkins MR. Risk factors, clinical presentation, and outcomes for abdominal wall endometriosis. Journal of minimally invasive gynecology. 2017;24(3):478-84. Carsote M, Terzea DC, Valea A, Gheorghisan-Galateanu A-A. Abdominal wall endometriosis (a narrative review). International journal of medical sciences. 2020;17(4):536. Paramythiotis D, Karlafti E, Tsomidis I, Iraklis G, Malliou P, Karakatsanis A, et al. Abdominal wall endometriosis: a case report. Pan African Medical Journal. 2022;41(1). Machairiotis N, Vasilakaki S, Thomakos N. Inflammatory mediators and pain in endometriosis: a systematic review. Biomedicines. 2021;9(1):54. Chantalat E, Valera M-C, Vaysse C, Noirrit E, Rusidze M, Weyl A, et al. Estrogen receptors and endometriosis. International journal of molecular sciences. 2020;21(8):2815. Raza S, Maqsood R, Siddiqi HA. Abdominal wall endometriosis. J Coll Physicians Surg Pak. 2010;20(1):60-1. Ramirez NBL. Cesarean Scar Endometriosis Incidence and Risk Factors After Primary Cesarean Delivery: The University of Arizona; 2024. Saliba C, Jaafoury H, El Hajj M, Nicolas G, Ahmad HH. Abdominal wall endometriosis: a case report. Cureus. 2019;11(2). Filip L, Duic? F, Pr?datu A, Cre?oiu D, Suciu N, Cre?oiu SM, et al. Endometriosis associated infertility: a critical review and analysis on etiopathogenesis and therapeutic approaches. Medicina. 2020;56(9):460. Smolarz B, Szy??o K, Romanowicz H. Endometriosis: epidemiology, classification, pathogenesis, treatment and genetics (review of literature). International journal of molecular sciences. 2021;22(19):10554. Moore J, Copley S, Morris J, Lindsell D, Golding S, Kennedy S. A systematic review of the accuracy of ultrasound in the diagnosis of endometriosis. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2002;20(6):630-4. Guerriero S, Conway F, Pascual MA, Graupera B, Ajossa S, Neri M, et al. Ultrasonography and atypical sites of endometriosis. Diagnostics. 2020;10(6):345. Kinkel K, Frei KA, Balleyguier C, Chapron C. Diagnosis of endometriosis with imaging: a review. European radiology. 2006;16(2):285-98. Clement PB. The pathology of endometriosis: a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects. Advances in anatomic pathology. 2007;14(4):241-60. Hemalatha A, Sindhuram S, Sushma S, Suma J, Varna I, Aditya A. Ultrasound Guided Fnac of Abdominal–Pelvic Masses-The Pathologists’ Perspective. Journal of clinical and diagnostic research: JCDR. 2013;7(2):273. Donnez J, Dolmans M-M. Endometriosis and medical therapy: from progestogens to progesterone resistance to GnRH antagonists: a review. Journal of clinical medicine. 2021;10(5):1085. Working group of ESGE E, WES, Keckstein J, Becker CM, Canis M, Feki A, et al. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Human Reproduction Open. 2020;2020(1):hoaa002. Zhang P, Sun Y, Zhang C, Yang Y, Zhang L, Wang N, et al. Cesarean scar endometriosis: presentation of 198 cases and literature review. BMC women's health. 2019;19(1):14. Keckstein J, Becker CM, Canis M, Feki A, Grimbizis GF, Hummelshoj L, et al. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Facts, Views & Vision in Obgyn. 2019;11(4):269-97. Nouri K, Ott J, Krupitz B, Huber JC, Wenzl R. Family incidence of endometriosis in first-, second-, and third-degree relatives: case-control study. Reproductive Biology and Endocrinology. 2010;8(1):85. Guo S-W. The quest for genetic sequence variants conferring risk of endometriosis. Human Reproductive Genetics: Elsevier; 2020. p. 91-109.