Sonographic Findings of Abdominal Wall Endometriosis in Persistent Abdominal Wall Pain: A Case Report

Stanislav Macháč, Šárka Hanušová, Michaela Hroncová, Jan Drahoňovský
In: Journal of Women's & Pelvic Health Physical Therapy · 2023 · vol. 47(4) , pp. 265–270 · doi:10.1097/jwh.0000000000000277 · W4391980713
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This case report describes musculoskeletal sonography findings in a patient with persistent abdominal wall pain post-cesarean delivery, identifying endometriosis lesions that were surgically removed, leading to improved pain and quality of life.

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Abstract

Introduction/Background: Endometriosis is considered a chronic neuroinflammatory disease of debilitating pain, most often in the pelvic area. In rare cases, endometriosis can develop through iatrogenic implantation of endometrial cells/fragments into a scar area during the cesarean delivery. Case Description: A case of a 32-year-old female patient who underwent physical therapy for abdominal muscle pain with occasional irradiation of pain to the sacral region is presented. The pain developed soon after a cesarean delivery, which was performed 3 years ago. Outcomes: Palpation performed at the initial examination and after removal of the lesions showed a significant reduction in tone at the site of the lesions and a reduction in palpation pain. The objective primary tools and specific outcome measures used in this case were musculoskeletal sonography and a patient questionnaire (36-Item Short Form Health Survey [SF-36]). Abdominal wall lesions were found to be 34 × 13 × 40 mm and 30 × 15 × 22 mm in size and were surgically removed by a specialized surgeon with histological confirmation of endometriosis. The SF-36 scores considerably improved in all domains following removal of the lesions compared with the condition at the initial examination. Discussion: The presented case is an example of the musculoskeletal sonography evaluation following palpation of the abdominal wall in women after a cesarean delivery. The described sonographic examination performed by a physical therapist can be part of a comprehensive assessment of scar healing, diastasis, and the ability to activate the abdominal muscles during postpartum rehabilitation. Informed Consent: The patient signed informed consent, in which she agreed to the anonymous publication of her case. A supplemental video abstract available at: https://www.youtube.com/watch?v=Vd87WB8ZQd0&t=16s

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Condition tags

endometriosis

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