Nicely Taylor, Lim Lauren, Willette Avarie, Legiec Julia R, Rawiji Hussain
Obstetrics and Gynecology, Lake Erie College of Osteopathic Medicine, Bradenton, USA.
College of Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA.
Cureus. 2025 Mar 9;17(3):e80286. doi: 10.7759/cureus.80286. eCollection 2025 Mar.
Endometriosis is becoming a well-discussed topic in the medical field of women's health, but rare and uncommon pathologic cases such as abdominal wall endometriosis are often overlooked in a patient's differential diagnoses. This is likely due to the need for greater awareness of its diverse clinical presentations, its impact on patient well-being, and the limitations in clinical suspicion, imaging accuracy, and treatment approaches. Although abdominal wall endometriosis is increasingly diagnosed, healthcare providers remain hesitant to prioritize it - along with endometriosis in general - as a primary diagnosis. In this paper, we discuss a case of a 51-year-old perimenopausal G2P2 female who presented to the emergency department with chief complaint of heavy vaginal bleeding for the past week. Physical exam revealed mild tenderness in the suprapubic area with notable diffuse masses, but was otherwise normal with no mass felt on abdominal palpation. Initial lab results at admission showed hemoglobin at a critical value of 5.4, for which the patient was immediately started on red blood cell transfusion. A transvaginal pelvic ultrasound resulted in fibroid uterus, normal sonographic appearance of endometrial complex, and nonvisualization of either ovary. Given the patient's extensive reproductive history and the need to rule out common causes of abnormal uterine bleeding, such as fibroids, adenomyosis, endometrial hyperplasia, and malignancy, the decision was made to proceed with a supracervical subtotal hysterectomy with bilateral salpingo-oophorectomy. During the procedure, an incidental abdominal mass was discovered and partially resected to allow for further investigation. After being reviewed by pathology, a rare finding was revealed, that is, abdominal wall endometriosis. The emphasis of this case is to describe the rarity of abdominal wall endometriosis, the clinical significance of early recognition by including abdominal wall endometriosis in the differential list, and to explore the different diagnostic and treatment modalities available, and all with the goal of providing further awareness for clinicians to consider abdominal wall endometriosis as a diagnosis in women premenarche, perimenopause, and postmenopause.
子宫内膜异位症正成为女性健康医学领域中一个备受讨论的话题，但诸如腹壁子宫内膜异位症等罕见和不常见的病理病例在患者的鉴别诊断中常常被忽视。这可能是由于需要提高对其多样临床表现、对患者健康的影响以及临床怀疑、影像准确性和治疗方法局限性的认识。尽管腹壁子宫内膜异位症的诊断越来越多，但医疗服务提供者仍然不愿将其（以及一般的子宫内膜异位症）作为主要诊断优先考虑。在本文中，我们讨论了一例51岁围绝经期G2P2女性患者，她因过去一周阴道大量出血为主诉就诊于急诊科。体格检查发现耻骨上区域轻度压痛，有明显的弥漫性肿块，但其他方面正常，腹部触诊未触及肿块。入院时的初始实验室检查结果显示血红蛋白临界值为5.4，患者立即开始接受红细胞输血。经阴道盆腔超声检查显示子宫肌瘤、子宫内膜复合体超声表现正常，双侧卵巢未显示。鉴于患者丰富的生育史以及需要排除子宫异常出血的常见原因，如肌瘤、子宫腺肌病、子宫内膜增生和恶性肿瘤，决定进行次全子宫切除术加双侧输卵管卵巢切除术。手术过程中，偶然发现一个腹部肿块并部分切除以便进一步检查。经病理检查后，发现了一个罕见的情况，即腹壁子宫内膜异位症。本病例的重点是描述腹壁子宫内膜异位症的罕见性、通过在鉴别诊断清单中纳入腹壁子宫内膜异位症进行早期识别的临床意义，并探讨可用的不同诊断和治疗方式，所有这些都是为了提高临床医生对腹壁子宫内膜异位症的认识，以便在青春期前、围绝经期和绝经后女性中考虑将其作为一种诊断。
