Incidence, diagnosis and management of abdominal wall endometriomas: a retrospective study and literature review

Catherine Kilada, Nikodem Banko, Martine Louis, Nageswara Mandava
In: International Surgery Journal · 2026 · vol. 13(5) , pp. 793–796 · doi:10.18203/2349-2902.isj20261173 · W7156050842
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This retrospective study characterized abdominal wall endometriosis in ten patients, finding it associated with cesarean sections and treatable with surgical excision for symptom improvement.

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This retrospective single-institution study and literature review examined the incidence, presentation, diagnostic evaluation, and surgical outcomes of abdominal wall and umbilical endometriomas, identifying 10 pathologically confirmed cases (8 abdominal wall, 2 umbilical). Patients commonly presented with localized abdominal wall pain and a palpable mass with possible cyclical exacerbation; all abdominal wall cases had a prior cesarean delivery, and imaging with MRI and CT was used selectively to characterize lesions and plan surgery. All patients underwent surgical excision with clear margins, with significant postoperative symptom improvement and no immediate complications, though the authors’ caveat is the small number of cases and retrospective design limited to a single center. This paper is centrally about endometriosis — it focuses on abdominal wall endometriomas, a rare extra-pelvic manifestation of endometriosis, which is closely related to but distinct from adenomyosis.

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Abstract

Abdominal wall endometriosis (AWE) is a rare extra pelvic manifestation of endometriosis, most commonly associated with prior cesarean section, and is frequently misdiagnosed due to nonspecific clinical features. This retrospective case study describes the presentation, diagnostic evaluation, and surgical outcomes of patients with abdominal wall and umbilical endometriosis at a single institution. Ten patients with pathologically confirmed endometriosis following surgical excision were identified. Eight cases involved the abdominal wall and two involved the umbilicus. All patients with abdominal wall lesions had a history of cesarean delivery, while neither patient with umbilical endometriosis had prior abdominal surgery. The most common presenting features were localized abdominal wall pain and a palpable mass, often with cyclical exacerbation. Magnetic resonance imaging and computed tomography were employed selectively for lesion characterization and operative planning. All patients underwent surgical excision with clear margins, resulting in significant postoperative symptom improvement and no immediate complications. Abdominal wall endometriosis should be considered in the differential diagnosis of abdominal wall masses, particularly in patients with a history of cesarean section and cyclical pain. Surgical excision remains the definitive treatment and is associated with excellent clinical outcomes.
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Incidence, diagnosis and management of abdominal wall endometriomas: a retrospective study and literature review DOI: https://doi.org/10.18203/2349-2902.isj20261173Keywords: Abdominal wall endometriosis, Cesarean scar endometriosis, Case study, Surgical excision, Endometrioma, Abdominal wall massAbstract Abdominal wall endometriosis (AWE) is a rare extra pelvic manifestation of endometriosis, most commonly associated with prior cesarean section, and is frequently misdiagnosed due to nonspecific clinical features. This retrospective case study describes the presentation, diagnostic evaluation, and surgical outcomes of patients with abdominal wall and umbilical endometriosis at a single institution. Ten patients with pathologically confirmed endometriosis following surgical excision were identified. Eight cases involved the abdominal wall and two involved the umbilicus. All patients with abdominal wall lesions had a history of cesarean delivery, while neither patient with umbilical endometriosis had prior abdominal surgery. The most common presenting features were localized abdominal wall pain and a palpable mass, often with cyclical exacerbation. Magnetic resonance imaging and computed tomography were employed selectively for lesion characterization and operative planning. All patients underwent surgical excision with clear margins, resulting in significant postoperative symptom improvement and no immediate complications. Abdominal wall endometriosis should be considered in the differential diagnosis of abdominal wall masses, particularly in patients with a history of cesarean section and cyclical pain. Surgical excision remains the definitive treatment and is associated with excellent clinical outcomes. Metrics References Koninckx PR, Ussia A, Adamyan L, Wattiez A, Gomel V, Martin DC. Pathogenesis of endometriosis: the genetic–epigenetic theory. Fertil Steril. 2021;116(2):327-40. DOI: https://doi.org/10.1016/j.fertnstert.2018.10.013 Zhang J, Liu X. Clinicopathological features of abdominal wall endometriosis: a retrospective analysis of 151 cases. Clin Exp Obstet Gynecol. 2016;43(3):379-83. DOI: https://doi.org/10.12891/ceog2126.2016 Yang F, Zhang L, Liu Y, Zhou X, Wang H, Chen Y, et al. Spontaneous abdominal wall endometriosis without previous surgery: a case series and literature review. BMC Womens Health. 2023;23(1):112. Farland LV, Shah DK, Kvaskoff M, Missmer SA, Gaskins AJ, Zondervan KT, et al. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. 2019;46(3):355-68. Foley KG, Smart PJ, Hart AR. Abdominal wall endometriosis: imaging features and management. Radiographics. 2022;42(2):451-69. Farland LV, Shah DK, Kvaskoff M, Missmer SA, Gaskins AJ, Zondervan KT, et al. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. 2019;46(3):355-68. Carsote M, Terzea D, Valea A, Gheorghisan-Galateanu AA. Abdominal wall endometriosis (a narrative review). Int J Med Sci. 2020;17(4):536-42. DOI: https://doi.org/10.7150/ijms.38679 Benedetto C, Cacozza D, De Sousa Costa D, Ferrero S, Leone Roberti Maggiore U, Vercellini P, et al. Abdominal wall endometriosis: report of 83 cases. Int J Gynaecol Obstet. 2022;159(2):530-6. DOI: https://doi.org/10.1002/ijgo.14167 Stefanou SK, Tepelenis K, Stefanou CK, Karataglis D, Christodoulou E, Papachristos D, et al. Abdominal wall endometriosis: a case report. J Surg Case Rep. 2021;2021(4):rjab055. DOI: https://doi.org/10.1093/jscr/rjab055 Kumar RR. Spontaneous abdominal wall endometrioma: a case report. Int J Surg Case Rep. 2021;78:180-3. DOI: https://doi.org/10.1016/j.ijscr.2020.12.016 Jouini W, Litaiem N, Zaimi Y, Boussofara L, Sriha B, Zermani R, et al. Omphalolith: an underdiagnosed entity. Clin Case Rep. 2022;10(10):e6443. DOI: https://doi.org/10.1002/ccr3.6443 Pedersen KD, Seyer-Hansen M, Egekvist AG. Extrapelvic endometriosis is a difficult diagnosis. Ugeskr Laeger. 2022;184(20):V11210861. Pirson L, Absil G, Giet G, Lecuit C, De Toeuf M, Closon MC, et al. Villar’s nodule. Rev Med Liege. 2023;78(8):420-2. Kim YH, Wegehaupt AK, Wingo MT. A woman with recurrent umbilical bleeding: a case report. J Med Case Rep. 2022;16(1):444. DOI: https://doi.org/10.1186/s13256-022-03675-2 Youssef AT. The ultrasound of subcutaneous extrapelvic endometriosis. J Ultrason. 2020;20(82):e176-80. DOI: https://doi.org/10.15557/JoU.2020.0029 Porter J, Eisdorfer J, Yi C, Nguyen C. Multifocal abdominal endometriosis: a case report. J Surg Case Rep. 2020;2020(6):rjaa120. DOI: https://doi.org/10.1093/jscr/rjaa120 Deng Y, Xie H, He L, Ding Z, Zhang W. Umbilical endometriosis mimicking malignancy on 18F-FDG PET/CT. Clin Nucl Med. 2023;48(1):56-7. DOI: https://doi.org/10.1097/RLU.0000000000004459 Bahall V, De Barry L, Rampersad A. Clear cell carcinoma arising from abdominal wall endometriosis: a report of two cases and literature review. World J Oncol. 2022;20(1):86. DOI: https://doi.org/10.1186/s12957-022-02553-x

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