Endometriosis is a benign disease characterized by endometrial glands and stroma outside the endometrial cavity. We reported two cases of endometriosis of the abdominal wall, with subcutaneous and intramuscular localization, that became symptomatic a few years after a cesarean intervention. These cases have a clinical pattern quite similar to cutaneous endometriosis, but they are more difficult to diagnose through physical examination because they are barely palpable. In this sense, coupled with suggestive symptoms, ultrasound examination can confirm the clinical suspicion of endometriosis without the use of computed tomography and/or magnetic resonance imaging.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Rokitansky K (1860) U ¨ ber Uterusdru ¨sen-Neubildung. Z Gesellschaft Aerzte (Wien) 16:577–581
Fuldeore MJ, Soliman AM (2017) Prevalence and symptomatic burden of diagnosed endometriosis in the United States: national estimates from a cross-sectional survey of 59,411 women. Gynecol Obstet Invest 82:453–461
Davis AC, Goldberg JM (2017) Extrapelvic endometriosis. Semin Reprod Med 35:98–101
Bozkurt M, Çil AS, Bozkurt DK (2014) Intramuscular abdominal wall endometriosis treated by ultrasound-guided ethanol injection. Clin Med Res 12:160–165
Van den Bosch T, Van Schoubroeck D (2018) Ultrasound diagnosis of endometriosis and adenomyosis: state of the art. Best Pract Res Clin Obstet Gynaecol 51:16–24
Cocco G, Boccatonda A, D’Ardes D et al (2018) Mantle cell lymphoma: from ultrasound examination to histological diagnosis. J Ultrasound 21:339. https://doi.org/10.1007/s40477-018-0318-1
Alnafisah F, Dawa SK, Alalfy S (2018) Skin endometriosis at the caesarean section scar: a case report and review of the literature. Cureus 10:e2063
Mistrangelo M, Gilbo N, Cassoni P et al (2014) Surgical scar endometriosis. Surg Today 44:767–772
Burghaus S, Hildebrandt T, Fahlbusch C et al (2019) Standards used by a clinical and scientific endometriosis center for the diagnosis and therapy of patients with endometriosis. Geburtshilfe Frauenheilkd 79:487–497
Burney RO, Giudice LC (2012) Pathogenesis and pathophysiology of endometriosis. Fertil Steril 98:511–519
Wang PH, Juang CM, Chao HT et al (2003) Wound endometriosis: risk factor evaluation and treatment. J Chin Med Assoc 66:113–119
Oosterlynck DJ, Cornillie FJ, Waer M, Vandeputte M, Koninckx PR (1991) Women with endometriosis show a defect in natural killer activity resulting in a decreased cytotoxicity to autologous endometrium. Fertil Steril 56:45–51
Betrán AP, Ye J, Moller AB et al (2016) The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. PLoS ONE 11:e0148343
Zhao Y, Zhang J, Zamora J et al (2017) Increases in caesarean delivery rates and change of perinatal outcomes in low- and middle-income countries: a hospital-level analysis of two WHO surveys. Paediatr Perinat Epidemiol 31:251–262
Wicherek L, Klimek M, Skret-Magierlo J et al (2007) The obstetrical history in patients with Pfannenstiel scar endometriomas—an analysis of 81 patients. Gynecol Obstet Invest 63:107–113
Hufnagel D, Li F, Cosar E et al (2015) The role of stem cells in the etiology and pathophysiology of endometriosis. Semin Reprod Med 33:333–340
Hirsch M, Begum MR, Paniz É et al (2018) Diagnosis and management of endometriosis: a systematic review of international and national guidelines. BJOG 125:556–564
Kavoussi SK, Lim CS, Skinner BD et al (2016) New paradigms in the diagnosis and management of endometriosis. Curr Opin Obstet Gynecol 28:267–276
Guerriero S, Saba L, Pascual MA et al (2018) Transvaginal ultrasound vs. magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol 51:586–595
Batur A, Yavuz A, Ozgokce M et al (2016) The utility of ultrasound elastography in differentiation of endometriomas and hemorrhagic ovarian cysts. J Med Ultrason 43:395–400
Fawzy M, Amer T (2015) Efficacy of transabdominal sonoelastography in the diagnosis of caesarean section scar endometrioma: a pilot study. J Obstet Gynaecol 35:832–834
Savelli L, Manuzzi L, Di Donato N et al (2012) Endometriosis of the abdominal wall: ultrasonographic and Doppler characteristics. Ultrasound Obstet Gynecol 39:336–340
Conflict of interest
Authors declare no conflicts of interest.
Research involving human participants and/or animals
Written informed consent was obtained by both patients.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Cocco, G., Ricci, V., Boccatonda, A. et al. Focused ultrasound for the diagnosis of non-palpable endometriotic lesions of the abdominal wall: a not-uncommon surgical complication. J Ultrasound (2020). https://doi.org/10.1007/s40477-019-00425-x
- Abdominal wall
- Non-palpable mass
- Cesarean scar