Abdominal Wall Endometriosis: A Case Report and Literature Review of Pfannenstiel Incision Endometrioma

Nathan Zhang, Sedona Robrahn, Katherine R Thornburgh, Justin Moon, Muhammad K Ather, Colton P Boney, Joel A Yalowitz
Cureus · 2024 · vol. 16(8) , pp. e66223 · doi:10.7759/cureus.66223 · PMID:39238696 · PMC11374577 · W4401379043
case-report OA: gold CC0 ⤵ 2 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-10 ⓘ

This report details a rare case of abdominal wall endometrioma in a patient with a prior cesarean section scar, discussing its diagnosis, management with surgical excision, and potential interventional radiology treatments.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This case report and literature review describes a 39-year-old woman with prior Pfannenstiel cesarean delivery who initially had an incidental small abdominal wall nodule on CT during a laparoscopic cholecystectomy for acute cholecystitis, which was then managed with watchful waiting. Five months later, she returned with progressive pain that worsened with her menses, and repeat CT showed an enlarging cystic, spiculated mass adherent to the Pfannenstiel scar; labs were within normal limits and pregnancy testing was negative. The patient underwent complete open surgical excision, and biopsy confirmed endometrial gland and stroma consistent with an abdominal wall endometrioma, with discussion of imaging, diagnostic decision-making, and alternative interventional options such as radiofrequency ablation and focused ultrasound. As an individual case report with emphasis on imaging and management choices, the findings are limited in generalizability. This paper is centrally about endometriosis — it reports and contextualizes Pfannenstiel incision endometrioma in the abdominal wall with cyclic scar-related symptoms and histologic confirmation.

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Abstract

We depict a unique case of a 39-year-old woman who presented to the emergency department with complaints of right upper quadrant pain. Work-up and a computed tomography (CT) scan revealed acute cholecystitis and the patient underwent laparoscopic cholecystectomy without complication. At this time, an incidental mass was discovered in the subcutaneous fat adjacent to the abdominal wall. The patient returned six months later with progressive, cyclic abdominal pain since her last hospital admission. Initial admission lab work was within normal limits and a urine pregnancy test was negative. Physical exam revealed tenderness around her previous cesarean section scar. Repeat CT revealed an enlarging, spiculated mass adherent to the abdominal wall. After imaging confirmation, the patient underwent complete open surgical excision for the removal of the mass. Post-surgical biopsy confirmed endometrial gland and stroma consistent with abdominal wall endometrioma. The patient was discharged with adjuvant therapy and recommended follow-up with the surgeon and her obstetrician-gynecologist. The radiological diagnosis, guidelines, and decision-making for initiating interventional treatment are discussed in this report. Our purpose in documenting this case is to present a rare diagnosis of an atypical location for an endometrioma on the abdominal wall, in a patient with prior cesarean delivery. Although this patient was treated with open excision, different interventional radiology treatments from radiofrequency ablation and focused ultrasound were discussed. In doing so, we hope to contribute to the systematic literature review on surgical excision as a treatment option for Pfannenstiel incision endometrioma.

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endometriosisendometrioma

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