ABSTRACT
Background: Endometrial cell implantation after abdominal surgery, mainly after
caesarean section, may result in formation of endometrioma, which is usually
described to be of various sizes, and adjacent
to the surgical scar. Case: A 36-year old woman complaining of a mass of
the abdominal wall with pain during the
menstrual period, with a caesarean section 5 years earlier, presented a rounded
tumour not contiguous to the Pfannenstiel’s laparotomy scar, of hard
consistence, fixed and adherent to the deep abdominal wall structures,
located on the left paramedian epigastric region. Magnetic Resonance imaging
showed the nodule, involving the deep layers of the abdominal wall and the
distance from the laparotomic scar. Surgical removal was performed with wide
excision of the lesion, causing a large wall defect. After histological confirmation
(endometriosis) by frozen section, reconstruction of the abdominal wall
required prolene mesh grafting. After twelve months the patient is healthy. Conclusion: When abdominal wall endometrioma is located distant from the scar, perhaps more
frequently after Pfannenstiel’s laparotomic incision, the differential
diagnosis may be more difficult and MRI can help differentiating many of these
lesions, and histological confirmation should be obtained intraoperatively, by
frozen section, to allow an oncological resection if required.