*34-year-old female with left lower anterior abdominal wall lump which enlarges and becomes painful with menses. History of one previous C-sections.
What is the most likely diagnosis?
Answer
Answer: Abdominal wall endometriosis
Case Discussion:
US images demonstrate the ill-defined hypoechoic mass with cystic content in the abdominal wall, containing internal vascularity on Doppler examination. MRI images showing the solid enhancing mass in the abdominal wall.
Endometriosis is a disease caused by the presence of functional endometrial tissue in an anatomical location outside the uterus. Endometriosis is common among women of reproductive age. It is most common in the ovaries, sacrouterine ligament, rectovaginal septum, and pelvic peritoneum. Endometriosis may rarely be located to the vulva, vagina, appendix, stomach, liver, chest, bladder, umbilicus and inguinal canal. It has been first reported in 1975 that endometriosis foci may be detected around Pfannenstiel incision scar in patients who underwent cesarean section or gynecological surgery (1, 2).
References:
1. Aimakhu VE. Anterior abdominal wall endometriosis complicating a uteroabdominal sinus following classical cesarean section. Int Surg. 1975;60:103–104.
2. Singh KK, Lessells AM, Adam DJ, Jordan C, Miles WF, Macintyre IM, et al. Presentation of endometriosis to general surgeons: a 10-year experience. Br J Surg. 1995;82:1349–1351.