Painful endometrial implants to the abdominal wall: minimally invasive treatment with percutaneous cryoablation with laparoscopic assistance

In: BMJ Case Reports · 2025 · vol. 18(4) , pp. e261219 · doi:10.1136/bcr-2024-261219 · PMID:40240137 · W4409486932
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This case report details the successful cryoablation of painful abdominal wall endometrial implants using a laparoscopic-assisted, ultrasound-guided approach to avoid organ damage.

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Abstract

In this case report, we describe a young woman presenting with long-standing severe abdominopelvic pain caused by abdominal wall endometrial implants. Due to the location, surgical resection was felt to be excessively morbid. Cryoablation entails the image-guided insertion of specialised needles into the tissue to induce tissue freezing and necrosis for the treatment of a variety of disease processes. However, percutaneous cryoablation was deemed impractical due to the implant's location and risk of injury to the bladder and bowel. Using a hybrid approach of laparoscopic dissection of the bowel and bladder away from the abdominal wall to allow concurrent ultrasound-guided cryoablation, the implant was successfully ablated. Once recovered, she had a resolution of pain. Cryoablation is an effective method to treat painful endometrial implants to the abdominal wall with minimal morbidity.

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