Diagnosis and Management of Abdominal Wall Endometriosis: A Systematic Review and Clinical Recommendations

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Abstract

Importance

Abdominal wall endometriosis (AWE) is a rare but easily treated cause of pain in women, especially those who have undergone cesarean deliveries.

Objective

This article reviews the diagnosis and management of AWE, a condition that generally develops after surgery but may arise spontaneously. We present a systematic review of the existing literature on AWE, as well as our clinical recommendations for medical and surgical management.

Evidence Acquisition

We searched PubMed and other databases using the search criteria “abdominal wall endometriosis,” “abdominal wall endometriomas,” and “abdominal wall mass.” The references of those articles were then reviewed, and additional publications were evaluated.

Results

Many case reports and case series have been published describing AWE. The overall quality of evidence is poor due to the lack of prospective studies and heterogeneous descriptions of AWE lesions and treatment options. Based on the available literature, it appears that AWE may arise spontaneously but is generally associated with prior pelvic surgery. Abdominal wall endometriosis can be diagnosed with a careful history and physical examination. Imaging including ultrasound and magnetic resonance imaging can assist with localization of the lesions, and aid in surgical excision and management. Lesions that have been removed in their entirety are unlikely to reoccur.

Conclusions and Relevance

Although limited, the body of literature describing management of AWE suggests that it can be successfully treated in most patients with careful surgical planning.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to identify risk factors for abdominal wall endometriosis, counsel their patients on management options, and understand the utility of preoperative imaging.

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