title: Abdominal Wall Endometriosis Excision with Mesh Closure - Report of Two Cases.
abstract: Abdominal wall endometriosis (AWE) is a rare condition included in the differential diagnosis of an abdominal wall mass and/or pelvic pain in women of reproductive age. It usually occurs after pelvic surgery, most commonly caesarean section. Given the variable clinical presentation, diagnosis can be challenging if a high index of suspicion for AWE does not exist. Consequently, the correct diagnosis is often missed in the preoperative assessment. The presence of endometriosis in other locations can aid in the diagnosis, but other endometriotic lesions do not always exist. Image studies, particularly ultrasound and magnetic resonance imaging, can also be of help in the differential diagnosis. Even though new management techniques such as ultrasound-guided percutaneous cryoablation seem to be promising, surgical excision is still the mainstay of treatment. When the aponeurosis is involved, lesion excision might need to be followed by wall closure with the use of a mesh to lessen tissue tension. We present two typical cases of AWE after caesarean section, one of them recurrent, in patients with concurrent endometriosis of other locations. Total lesion excision followed by polypropylene mesh closure has been performed, with very good post-operative outcomes. We aim to raise awareness towards this diagnosis and to highlight the importance of complete lesion excision and adequate closure of the abdominal wall.
authors.affiliation: Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal.
authors.forename: Carolina
authors.initials: C
authors.lastname: Vaz-de-Macedo
authors.affiliation: Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Gomes-da-Costa
authors.affiliation: Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Mendes
authors.affiliation: Minimally Invasive Surgery, Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal.
authors.forename: Sónia
authors.initials: S
authors.lastname: Barata
authors.affiliation: Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal.
authors.forename: Conceição
authors.initials: C
authors.lastname: Alho
authors.affiliation: Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal.
authors.forename: Carlos Calhaz
authors.initials: CC
authors.lastname: Jorge
authors.affiliation: Obstetrics and Gynecology Department, Faculdade de Medicina de Lisboa, CAML, Centro Académico de Medicina de Lisboa, Hospital da Luz, Lisboa, Portugal.
authors.forename: Filipa
authors.initials: F
authors.lastname: Osório
mesh_terms: D034861:Abdominal Wall / Q000000981:diagnostic imaging* / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques / Q000295:instrumentation*; D000328:Adult; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D013526:Surgical Mesh; D016896:Treatment Outcome