Presentation
Right lower anterior abdominal wall lump which enlarges and becomes painful with menses. History of two previous C-sections.
Patient Data
The lower portion of the right rectus abdominis muscle shows an irregular enhancing, mainly solid, enhancing lesion measuring 5.3 x 4.4 x 4.1 cm, related to previous cesarean section scar.
Ultrasonography of the lesion showed it to be ill-defined, irregular, heterogenous, hypoechoic and having some vascularity within.
Case Discussion
With the right patient history, a right lower abdominal wall lesion is compatible with abdominal wall endometriosis related to C-section scar.
Abdominal wall endometriosis is the most common location of extrapelvic endometriosis and usually occurs after cesarean section. A wide spectrum of disorders should be considered in the differential diagnosis including neoplasms such as a sarcoma, desmoid tumor, or metastasis and non-neoplastic causes such as a suture granuloma, hernia, hematoma, or abscess. However, abdominal wall endometriosis should always be the prime consideration in patients with an abdominal wall mass near a cesarean section scar and the classical history of cyclical pain.