Anterior Abdominal Wall Endometriosis: A Series of Case Reports

INTRODUCTION: Endometriosis is a chronic, hormone-dependent, progressive and recurrent disease characterized by the existence of tissue outside the uterine cavity, similar to endometrium in the morphological and functional properties. This disease is gaining increasing medical and social significance due to its severe clinical manifestations and recurrent course, as well as a negative impact on the quality of life and working capacity of women. The incidence of abdominal wall endometriosis (AWE) that is referred to extragenital localization, is 0.3% to 3.5%. In most cases, it develops after cesarean section, less often after other gynecological operations (hysterectomy, removal of endometrioid ovarian cysts). Its recognition presents certain difficulties due to the necessity of differential diagnosis with postoperative hernias, ligature abscesses, hematomas and use of additional imaging methods. In this context, of interest is to study the clinical and history data, localization and management tactics for female patients with the anterior abdominal wall endometriosis.

AIM: Investigation of clinical presentation, diagnosis, treatment of one of the rarest and least studied forms of extragenital localization of endometriosis — AWE — and improvement of management tactics for patients with this pathology.

MATERIALS AND METHODS: A clinical analysis of AWE cases with several variants of its invasion was carried out in 7 female patients.

RESULTS: The age of the patients ranged from 27 to 39 years (median — 33 years). All the seven patients had a past cesarean section; the period after surgical delivery ranged from 3 to 7 years. Six patients reported pain in the area of the postoperative scar associated with the menstrual cycle, 1 noted the presence of a palpable formation of the anterior abdominal wall. During surgical treatment, excision of endometrioid infiltrates located in the area of the postoperative scar was performed, followed by histological verification.

CONCLUSION: Taking into account the relative rarity of AWE, the difficulty of its early identification, the need for differential diagnosis using additional examination methods, greater awareness of this disease is required among doctors of related specialties. Diagnostic alertness is especially relevant for patients with a history of surgical delivery if they have a formation in the area of a postoperative scar and a cyclic pain symptom in its projection.