Endometrioma of the Abdominal Wall after Caesarean Section

Background: Endometrial cell implantation after abdominal surgery, mainly aftercaesarean section, may result in formation of endometrioma, which is usuallydescribed to be of various sizes, and adjacentto the surgical scar. Case: A 36-year old woman complaining of a mass ofthe abdominal wall with pain during themenstrual period, with a caesarean section 5 years earlier, presented a roundedtumour not contiguous to the Pfannenstiel’s laparotomy scar, of hardconsistence, fixed and adherent to the deep abdominal wall structures,located on the left paramedian epigastric region. Magnetic Resonance imagingshowed the nodule, involving the deep layers of the abdominal wall and thedistance from the laparotomic scar. Surgical removal was performed with wideexcision of the lesion, causing a large wall defect. After histological confirmation(endometriosis) by frozen section, reconstruction of the abdominal wallrequired prolene mesh grafting. After twelve months the patient is healthy. Conclusion: When abdominal wall endometrioma is located distant from the scar, perhaps morefrequently after Pfannenstiel’s laparotomic incision, the differentialdiagnosis may be more difficult and MRI can help differentiating many of theselesions, and histological confirmation should be obtained intraoperatively, byfrozen section, to allow an oncological resection if required.