Presentation
Presented with a right sub-umbilical small mass lesion, tender and attached to the skin and subcutaneous tissue. It is immobile with a periodic increase in size and pain in relation to the menstrual cycle. The patient has a previous history of multiple cesarean sections.
Patient Data
The midline showed a right subcutaneous irregular shaped, homogenously slightly hyperdense soft tissue mass lesion that revealed mild enhancement. Associated with surrounding subcutaneous fat stranding and desmoid reaction (Gorgon sign). The feeding vessel for the major lesion could be detected and tracked.
An underlying facial defect is detected through (previous midline longitudinal scar) with protruding omental fat through the hernial orifice.
A similar lesion is noted lower in the midline resting on the linea alba, showing the same pattern of enhancement and effect.
The patient was operated for resection and mesh repair for the hernia.
Case Discussion
Abdominal wall endometrioma (AWE) is an uncommon aftermath of gynecologic operations such as a cesarean section or an abdominal hysterectomy. The incidence varies from 1 to 2% 1.
Clinically, the diagnosis is based on the Esquivel triad, which comprises a palpable nodular mass, cyclic pain, and a history of lower cesarean section, which is virtually diagnostic of AWE 2.
The exact location, size, and nature of the mass based on contrast enhancement are diagnostic 3. MRI has better contrast resolution than CECT and ultrasound 4.
Fine needle aspiration cytology (FNAC) runs the risk of needle track implantation of the endometriotic lesion. Excisional biopsy is the gold standard.
The differential diagnosis may include a variety of conditions such as hernia, lipoma, desmoid tumor, or primary or metastatic malignancy 5.
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