Extrapelvic Location: Abdominal Wall Endometriosis. Diagnostic and Interventional Imaging

In: Imaging of Endometriosis: A Comparative Guide of US, MRI and Surgery · 2025 · pp. 243–259 · doi:10.1007/978-3-031-82750-1_13 · W4410897496
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Abdominal wall endometriosis, a rare extrapelvic variant, presents with pain and challenges in diagnosis, often requiring ultrasound, MRI, and potentially biopsy, with hormonal therapy as initial treatment and surgery for failure.

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This chapter reviews abdominal wall endometriosis (AWE), an uncommon extrapelvic endometriosis variant, focusing on how it presents with pain and how it is diagnosed and treated using abdominal ultrasound as first-line imaging followed by MRI with sequences both with and without contrast. In complex cases, it describes the use of fine-needle aspiration or percutaneous biopsy and notes that hormonal therapy is the initial treatment, while surgical excision is used when therapy fails, despite operative risks tied to abdominal wall anatomy, prosthetic implantation needs, and higher recurrence over time. It also surveys minimally invasive interventional radiology approaches such as cryoablation, radiofrequency, microwave, and high-intensity focused ultrasound, citing promising outcomes including pain relief and cosmetic effects, while emphasizing that definitive roles and long-term follow-up outcomes require extensive multicenter prospective studies. This paper is centrally about endometriosis — it specifically addresses abdominal wall endometriosis diagnosis and minimally invasive interventional imaging and treatment considerations.

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Abstract

Abdominal wall endometriosis (AWE) is a rare variant of extrapelvic endometriosis that is characterized by the presence of endometriotic cells within the abdominal wall, primarily manifesting as pain and significantly impacting patients’ quality of life. Diagnosis can be challenging but typically involves the first-line use of abdominal ultrasound, followed by magnetic resonance imaging (MRI), which should include morphological sequences both with and without contrast enhancement. In complex cases, fine-needle aspiration (FNA) or percutaneous biopsy may be conducted. Hormonal therapy is the initial treatment approach, with surgical excision offered in cases of therapeutic failure. Although effective, surgery carries risks due to the anatomical and physiological complexity of the abdominal wall, including the need for prosthetic material implantation and an increased risk of recurrence over time. Minimally invasive interventional techniques have evolved over the years, showing promising results in terms of both pain management and cosmetic outcomes, with their use expanding globally through advances in interventional radiology (IR). Furthermore, basic research is crucial for enhancing our understanding of the pathophysiology of this condition and for optimizing treatment techniques to maximize efficacy while minimizing morbidity. Extensive multicenter prospective studies are needed to ascertain the definitive role of minimally invasive techniques in the therapeutic arsenal for treating endometriosis and to evaluate outcomes during follow-up. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others Abbreviations - AWE: - Abdominal wall endometriosis - CA: - Cryoablation - CNB: - Core needle biopsy - CO2: - Carbon dioxide - CT: - Computed tomography - DWI: - Diffusion-weighted imaging - FNA: - Fine-needle aspiration - GA: - General anesthesia - HIFU: - High-intensity focused ultrasound - IR: - Interventional radiology - MRI: - Magnetic resonance imaging - MW: - Microwave - NSAIDs: - Nonsteroidal anti-inflammatory drugs - RFA: - Radiofrequency - SUV: - Standard uptake value - US: - Ultrasound

References

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Springer, Cham. https://doi.org/10.1007/978-3-031-82750-1_13 Download citation DOI: https://doi.org/10.1007/978-3-031-82750-1_13 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-031-82749-5 Online ISBN: 978-3-031-82750-1 eBook Packages: MedicineMedicine (R0)

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