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by qwen3.7-flash, 2026-09-15
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This retrospective case series examines two women aged 41 and 44 who presented with progressively enlarging, painful masses in the right lower abdominal wall following previous caesarean sections. Contrast-enhanced CT imaging identified soft tissue lesions within the rectus abdominis muscle, which were subsequently managed through wide surgical excision and polypropylene mesh reconstruction to ensure adequate margins. Histopathological analysis confirmed the presence of ectopic endometrial glands and stroma, validating the diagnosis of abdominal wall endometriosis after both patients experienced complete symptom resolution without complications. This paper is centrally about endometriosis — specifically the clinical presentation, diagnosis, and surgical management of abdominal wall endometriosis (AWE) as a rare extra-pelvic manifestation.
Abstract
Abdominal wall endometriosis (AWE) is an uncommon presentation of extra-pelvic endometriosis, most frequently developing following gynaecological surgeries, particularly caesarean sections. The study aims to describe the clinical characteristics, diagnostic process, surgical management, and outcomes in two post-caesarean patients diagnosed with AWE, while highlighting the importance of early recognition. This research is a retrospective descriptive case series. We used purposive sampling of two patients with histopathologically confirmed AWE. Two women, aged 41 and 44 years, presented with a gradually enlarging palpable mass in the right lower abdominal wall, accompanied by local tenderness and cyclical pain during menstruation. Symptom duration was 14 years in the 41-year-old and 7 years in the 44-year-old, both with a history of caesarean section. Contrast-enhanced CT scans revealed soft tissue lesions within the rectus abdominis muscle extending into subcutaneous tissue. Both patients underwent wide surgical excision with adequate margins, followed by polypropylene mesh reconstruction due to lesion size. Histopathology confirmed ectopic endometrial glands and stroma. Both patients recovered without complications and reported complete resolution of symptoms at follow-up. Masses in the right lower abdominal wall with a history of caesarean section are frequently misdiagnosed due to multiple differential diagnoses, including desmoid tumours, hernias, lipomas, hematomas, and suture granulomas. AWE should be considered in women presenting with cyclical abdominal wall pain and a history of caesarean section. Early wide surgical excision with appropriate reconstruction provides excellent outcomes. Improved clinical awareness is essential to reduce diagnostic delays and enhance patient quality of life.
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Abdominal Wall Endometriosis : Case Series
DOI:
https://doi.org/10.55324/enrichment.v3i10.600Keywords:
Abdominal wall endometriosis, AWE, Endometrial glands and stromaAbstract
Abdominal wall endometriosis (AWE) is an uncommon presentation of extra-pelvic endometriosis, most frequently developing following gynaecological surgeries, particularly caesarean sections. The study aims to describe the clinical characteristics, diagnostic process, surgical management, and outcomes in two post-caesarean patients diagnosed with AWE, while highlighting the importance of early recognition. This research is a retrospective descriptive case series. We used purposive sampling of two patients with histopathologically confirmed AWE. Two women, aged 41 and 44 years, presented with a gradually enlarging palpable mass in the right lower abdominal wall, accompanied by local tenderness and cyclical pain during menstruation. Symptom duration was 14 years in the 41-year-old and 7 years in the 44-year-old, both with a history of caesarean section. Contrast-enhanced CT scans revealed soft tissue lesions within the rectus abdominis muscle extending into subcutaneous tissue. Both patients underwent wide surgical excision with adequate margins, followed by polypropylene mesh reconstruction due to lesion size. Histopathology confirmed ectopic endometrial glands and stroma. Both patients recovered without complications and reported complete resolution of symptoms at follow-up. Masses in the right lower abdominal wall with a history of caesarean section are frequently misdiagnosed due to multiple differential diagnoses, including desmoid tumours, hernias, lipomas, hematomas, and suture granulomas. AWE should be considered in women presenting with cyclical abdominal wall pain and a history of caesarean section. Early wide surgical excision with appropriate reconstruction provides excellent outcomes. Improved clinical awareness is essential to reduce diagnostic delays and enhance patient quality of life.
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