SonoWorld.com uses cookies to improve your experience on the site. Your continued use of the site constitutes your acceptance of use of cookies on this site.
Find out more about how SonoWorld uses cookies. I’m OK with Cookies from SonoWorld - stop showing me this banner.
×
 
184,422 Registered Members as of 11/26/2020.
Abdomen » Peritoneal Cavity
Abdominal Wall Endometriosis
« Back to Listing
 
 
Presentation

36-year-old female patient with bulge in the right paramediana infraumbilical region. This bulge is painful and increases in intensity during menstruation.

History of cesarean section 7 years ago.

 
 
 
Caption: Transversal sonogram of the infraumbilical abdominal wall (Extended view)
Description: Transversal sonogram shows nodule located in the deep subcutaneous plane adjacent to the fascia of the right abdominal rectum.
 
 
 
Caption: Sagittal (A) and Transversal (B) sonogram of the of the right infraumbilical abdominal wall
Description: The sonogram shows an irregular, mainly solid, heterogenous and hypoechoic nodule, measuring 1.89 x 0.93 x 1.37cm; vol: 1.27cc related to previous cesarean section scar. Located in the deep subcutaneous plane adjacent to the fascia of the right abdominal rectum.
 
 
 
Caption: Transversal sonogram of the right infraumbilical abdominal wall.
Description: Transversal sonogram shows an irregular, mainly solid, heterogenous and hypoechoic nodule with increased vascularization to the color doppler study showing medium resistance flow (IR: 0.65)
 
 
Caption: Transverse sonogram of the of the right infraumbilical abdominal wall.
Description: The sonogram shows an irregular, mainly solid, heterogenous and hypoechoic nodule related to previous cesarean section scar. Located in the deep subcutaneous plane adjacent to the fascia of the right abdominal rectum.
 
 
Caption: Sagittal sonogram of the of the right infraumbilical abdominal wall.
Description: The sonogram shows an irregular, mainly solid, heterogenous and hypoechoic nodule related to previous cesarean section scar. Located in the deep subcutaneous plane adjacent to the fascia of the right abdominal rectum.
 
 
Caption: Transversal sonogram of the right infraumbilical abdominal wall.
Description: Transversal sonogram shows an irregular, mainly solid, heterogenous and hypoechoic nodule with increased vascularization to the color doppler study.
 
Differential Diagnosis

Abdominal wall endometriosis is the most common location of extrapelvic endometriosis and usually occurs after cesarean section.

 

A wide spectrum of disorders should be considered in the differential diagnosis including2:

-neoplasms: sarcoma, desmoid tumor or metastasis;

-non-neoplastic: suture granuloma, hernia, hematoma or abscess.

 

However, abdominal wall endometriosis should always be the prime consideration in patients with an abdominal wall mass near a cesarean section scar and the classical history of cyclical pain5.

 
Final Diagnosis

Abdominal wall endometriosis

 
Discussion

Scar endometriosis is a term given to endometriosis occurring in a Cesarian section scar. It can be located in the skin, subcutaneous tissue, rectus muscle/sheath, intraperitoneally, or in the uterine myometrium (within uterine scar)1.

 

The reported incidence of abdominal scar endometriosis following Cesarean section is 0.03-0.6% 3.

 

Patients may complain of tenderness to palpation and a raised, unsightly hypertrophic scar. Most patients have cyclical pain (up to 70%)4. The pain is usually intermittent and associated with the patient's menstrual cycle but it may be constant in nature. Some reports state that only as low as 20% of the patients exhibited cyclical symptoms. The overlying skin may be hyperpigmented due to deposition of hemosiderin. Some patients may be asymptomatic2.

 

Sonographic features are not specific. A subcutaneous nodule having relatively irregular borders, a heterogeneous echotexture with internal scattered hyperechoic echoes surrounded by a hyperechoic ring of variable width, and vascularity may be present. Occasionally cystic changes may be present3.

 

 
Case References

1.-Gajjar KB, Mahendru AA, Khaled MA. Caesarean scar endometriosis presenting as an acute abdomen: a case report and review of literature. Arch. Gynecol. Obstet. 2008;277 (2): 167-9. doi:10.1007/s00404-007-0431-4 - Pubmed citation

 

2.-Gidwaney R, Badler RL, Yam BL et-al. Endometriosis of abdominal and pelvic wall scars: multimodality imaging findings, pathologic correlation, and radiologic mimics. Radiographics. 2012;32 (7): 2031-43. doi:10.1148/rg.327125024 - Pubmed citation

 

3.-Hensen JH, Van breda vriesman AC, Puylaert JB. Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography. AJR Am J Roentgenol. 2006;186 (3): 616-20. doi:10.2214/AJR.04.1619 - Pubmed citation

 

4.-Ozel L, Sagiroglu J, Unal A et-al. Abdominal wall endometriosis in the cesarean section surgical scar: a potential diagnostic pitfall. J. Obstet. Gynaecol. Res. 2012;38 (3): 526-30. doi:10.1111/j.1447-0756.2011.01739.x - Pubmed citation

 

5.-Danielpour PJ, Layke JC, Durie N et-al. Scar endometriosis - a rare cause for a painful scar: A case report and review of the literature. Can J Plast Surg. 2011;18 (1): 19-20. Free text at pubmed - Pubmed citation

 

 
Technical Details

Ultrasound scanner. – Affiniti 70. Phillips.

Transducer. - 4-18MHz linear array.

Scanning in both transverse and longitudinal planes.

 
Follow Up

Surgical excision of lesion was done. Histopatholgy revealed scar endometriosis.

 
Other contents by this Author