Endometriosis of the abdominal wall. A rare, under-recognized entity causing chronic abdominal wall pain
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76 Hellenic Journal of Surgery 2012; 84: 1
Surgery οf Colon Cancer in a District Hospital
Endometriosis of the Abdominal Wall. Α Rare, Under-Recognized Entity Causing Chronic Abdominal Wall Pain Case Report S. V. Kontostolis, A. Vitsas, E. Boultadakis, K. Stamatiou, P. G. Sfikakis Received 16/09/2011 Accepted 19/10/2011
Abstract Endometriosis is a common gynaecological condition which affects women during their reproductive years. It is characterized by ectopic endometrial tissue responding to hormonal changes associated with menstrual cycle. Aetiology is unknown and symptoms are quite aspecific (dysmenorrhoea, pelvic pain, infertility or pelvic mass). Ηere we report the case of a 43-year-old woman, who presented with complaints of chronic abdominal wall pain and lower abdominal discomfort during menstruation. Symptoms persisted for more than nine months. Clinical and ultrasound evaluation raised the suspicion of abdominal wall endometriosis; surgical exploration confirmed diagnosis. The patient progressed satisfactorily and is free of symptoms 20 months after surgery. Abbreviations: Chronic abdominal wall pain (CAWP), abdominal wall endometriosis (AWE), computed tomography (CT), magnetic resonance imaging (MRI).
Key words:
Endometriosis, Chronic abdominal wall pain
Introduction Chronic abdominal wall pain (CAWP) originating from the abdominal wall is moderate to sharp and there is usually tenderness upon gentle stroking or pinching in that area of the skin. It is often misdiagnosed as arising from a source inside the abdominal cavity, which often results in inappropriate diagnostic investigations, unsatisfactory treatment, and considerable costs [1]. The aetiology is usually simple in origin and remains unknown until surgical intervention reveals the cause, at which stage rap-
S. V. Kontostolis, A. Vitsas, E. Boultadakis, P. G. Sfikakis (Corresponding author) - 2nd Surgical Department, “Tzaneion” General Hospital, Piraeus, Greece K. Stamatiou - Urology Department, “Tzaneion” General Hospital, Piraeus, Greece e-mail: [email protected]
id diagnosis and surgery is required [2]. The most usual cause of CAWP is entrapment of a branch of one of the lower thoracic intercostal nerves in the abdominal wall muscle. Other diseases affecting the nerves, such as diabetes, herpes zoster, trauma and rarely, cancer, may also cause symptoms of CAWP [1]. Occasionally, abdominal wall haematomas, hernias and painful rib may account for abdominal wall pain [3]. Abdominal wall endometriosis (AWE) is an extremely rare cause of CAWP, accounting for less than 1% of the cases [2]. Ηere we report the case of a 43-year-old woman, who presented with complaints of chronic abdominal wall pain and lower abdominal discomfort during menstruation. Apropos to this interesting case, we discuss the pathogenesis, presentation and treatment options of this enigmatic disease.
Case Presentation A 43-year-old woman presented to the outpatient department, complaining of CAWP and lower abdominal discomfort during menstruation. Symptoms had persis
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