Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases

Background: Abdominal wall endometriosis (AWE) is defined as endometrial tissue superficial to the peritoneum. AWE often is misdiagnosed and referred to surgeons for treatment. We performed a systematic review of published cohorts to quantify demographics, symptoms, and outcomes of patients having AWE. Methods: An English language PubMed search from January 1951 to August of 2006 was conducted using several search terms for endometrioma. Conclusions: Twenty-nine articles describing 455 patients were identified and met inclusion criteria. The pooled mean age was 31.4 years. Ninety-six percent presented with a mass, 87% presented with pain, and 57% presented with cyclic symptoms. AWE was associated with a caesarian scar or hysterectomy in 57% and 11% of cases, respectively. The interval from index surgery to presentation was 3.6 years. Recurrence after resection was 4.3%. The most common presentation of AWE is the development of a painful mass after uterine surgery. Surgical treatment appears to result in a cure more than 95% of the time.