Abdominal wall endometriosis with round ligament connection

Case contributed by Dr Roberto Pais

Presentation

Localized pain in the hypogastric region with no prior history of abdominal or pelvic surgical interventions or pregnancy.

Patient Data

Age: 30 years
Gender: Female

T2 WI shows abdominal wall endometriosis (AWE) lesion located ventrally to the rectus abdominis with iso-hypointense signal.

DWI b1000 show slight diffusion restriction in the AWE lesion.

T2 WI with fat saturation show hyperintense signal.

T1 WI with fat saturation shows filiform structure extending from the uterus to the AWE lesion with similar slight hyperintense signal on both findings.

T1 WI with fat saturation with gadolinium administration shows similar increased hyperintense signal in the filiform and abdominal wall lesions.

Case Discussion

This is a rare case of abdominal wall endometriosis with a uterine connection in a woman with no previous history of gynecologic or obstetric pathology and/or surgical interventions with localized persistent pain cyclically aggravated by menses in the right side hypogastric region for several months and small palpable mass in the referred location. The mass was also cyclically more palpable during menses. 

The MRI study revealed a lesion in the anterior abdominal wall (AAW), adjacent to the rectus abdominis, without a clear cleavage plane and with 17,6mm. It also showed a filliform sinuous formation, extending anteroposteriorly from the lesion in the AAW to the uterine cavity fundus and with approximately 25mm.

In all the performed sequences the signal behavior in both findings and the uterine cavity is identical.

No other intra or extra-pelvic endometriosis lesions were found.

Extra pelvic endometriosis is a rare condition and occurs mostly due to transplantation of uterine endometrium through lymphatic, vascular, or iatrogenic dissemination. The most common site it occurs is in the abdominal wall as a result of abdominal or pelvic surgery scar and it has an incidence of 0,1%. 

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