Diagnosis and Management of Abdominal Wall Endometriosis: A Systematic Review and Clinical Recommendations
Abstract
Importance: Abdominal wall endometriosis (AWE) is a rare but easily treated cause of pain in women, especially those who have undergone cesarean deliveries. Objective: This article reviews the diagnosis and management of AWE, a condition that generally develops after surgery but may arise spontaneously. We present a systematic review of the existing literature on AWE, as well as our clinical recommendations for medical and surgical management. Evidence Acquisition: We searched PubMed and other databases using the search criteria “abdominal wall endometriosis,” “abdominal wall endometriomas,” and “abdominal wall mass.” The references of those articles were then reviewed, and additional publications were evaluated. Results: Many case reports and case series have been published describing AWE. The overall quality of evidence is poor due to the lack of prospective studies and heterogeneous descriptions of AWE lesions and treatment options. Based on the available literature, it appears that AWE may arise spontaneously but is generally associated with prior pelvic surgery. Abdominal wall endometriosis can be diagnosed with a careful history and physical examination. Imaging including ultrasound and magnetic resonance imaging can assist with localization of the lesions, and aid in surgical excision and management. Lesions that have been removed in their entirety are unlikely to reoccur. Conclusions and Relevance: Although limited, the body of literature describing management of AWE suggests that it can be successfully treated in most patients with careful surgical planning. Target Audience: Obstetricians and gynecologists, family physicians. Learning Objectives: After completing this activity, the learner should be better able to identify risk factors for abdominal wall endometriosis, counsel their patients on management options, and understand the utility of preoperative imaging.
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CS is responsible for 57-92% of AWE cases.
“Studies reveal that CS is responsible for 57–92% of AWE cases [3,5,23,26,32,33,34,35,36,37].”
From Surgical Reconstruction of Abdominal Wall Endometriosis Post-Cesarean Section: A Monocentric Experience of a Rare Pathology (2025) · cites this paper as [26]
The clinical improvements observed after medical therapy for implants located in other areas were not observed in parietal endometriosis.
“The clinical improvements observed after medical therapy for implants located in other areas were not observed in parietal endometriosis [26].”
From Surgical Reconstruction of Abdominal Wall Endometriosis Post-Cesarean Section: A Monocentric Experience of a Rare Pathology (2025) · cites this paper as [26]
Oral contraceptives and progestins may provide partial symptom relief but do not eliminate the lesion.
“Oral contraceptives and progestins may provide partial symptom relief but do not eliminate the lesion [19].”
From Umbilical port-site endometriosis: a case presentation and narrative review of the literature (2026) · cites this paper as [19]
This cooperative management is also recommended by Rindos et al.
“This cooperative management is also recommended by Rindos et al. [21].”
From Abdominal wall endometriosis: An 11-year retrospective observational cohort study (2019) · cites this paper as [21]
MRI allows evaluation of relationships with neighboring structures and planning of multidisciplinary management for abdominal wall reconstruction.
“MRI allows evaluation of relationships with neighboring structures and planning of multidisciplinary management for abdominal wall reconstruction (Fig. 1) [4,5,21].”
From Abdominal wall endometriosis: An 11-year retrospective observational cohort study (2019) · cites this paper as [21]
The majority of research includes instances of gynecologic surgery for benign conditions such as adenomyosis, uterine leiomyomas, and fibroids.
“The majority of research includes instances of gynecologic surgery for benign conditions such as adenomyosis, uterine leiomyomas, and fibroids [17,18]”
From Challenges in Diagnosis and Prevention of Iatrogenic Endometriosis as a Long-Term Surgical Complication after C-Section (2022) · cites this paper as [17]
Fine-needle aspiration can confirm the preoperative diagnosis of AWE, excluding malignancy.
“Fine‐needle aspiration can confirm the preoperative diagnosis of AWE, excluding malignancy.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [22]
MRI and CT are helpful for clarifying the extent of the lesion, fascia involvement, and depth of lesion invasion in AWE.
“MRI and CT are helpful for clarifying the extent of the lesion, fascia involvement, and the depth of lesion invasion.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [22]
To date, there has been no report demonstrating that hormonal therapy is effective for AWE.
“To date, there has been no report demonstrating that hormonal therapy is effective for AWE.”
From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [22]
Oral contraceptives and progesterone can attenuate symptoms only slightly but cannot eliminate the lesion.
“Oral contraceptives and progesterone can attenuate symptoms only slightly but cannot eliminate the lesion[3].”
From Laparoscopic umbilical trocar port site endometriosis: A case report (2020) · cites this paper as [3]
Surgical excision of normal tissue 5-10 mm away from the edge of the lesion is required to prevent recurrence.
“It is widely accepted that surgical excision is the most appropriate approach, and surgical excision of normal tissue 5-10 mm away from the edge of the lesion is required to prevent recurrence, according to the literature[3,5].”
From Laparoscopic umbilical trocar port site endometriosis: A case report (2020) · cites this paper as [3]
Abdominal wall endometriosis (AWE) can occur after gynecological and obstetric pelvic surgery, with approximately 57% of cases developing secondary to cesarean section.
“AWE can be spontaneous, but it can also occur after gynecological and obstetric pelvic surgery, with approximately 57% of cases developing secondary to cesarean section[3].”
From Laparoscopic umbilical trocar port site endometriosis: A case report (2020) · cites this paper as [3]
In extensive lesions, CT or MRI can assess the location and size of AWE more accurately than ultrasound; they can determine whether fascia and rectus abdominis muscles are involved and if preoperative surgical evaluation is needed for reticular repair of the abdominal wall.
“In the case of extensive lesions, computed tomography or magnetic resonance imaging can assess the location and size of AWE more accurately than ultrasound; moreover, they can prevail for the determination of whether to accumulate fascia and rectus abdominis muscles and if preoperative surgical evaluation is needed for reticular repair of the abdominal wall[3].”
From Laparoscopic umbilical trocar port site endometriosis: A case report (2020) · cites this paper as [3]
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- Authors
- Rindos, N. B., & Mansuria, S.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Rindos, Noah B.
- ORCID
- Rindos, Noah B.
- Venue
- Obstetrical & Gynecological Survey
- Published
- 2017-02
- Volume
- 72
- Issue
- 2
- Pages
- 116-122
- ISSN
- 0029-7828 (ISSN-L)
- 1533-9866
- OpenAlex
- W2588698508
- Semantic Scholar
- fd7d5d99e2b856a4a9b964ec611733a1a4e6a2aa
- Cited by
- 82
- References
- 24
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 9 · 2023: 4 · 2022: 9 · 2021: 11 · 2020: 14 · 2019: 6 · 2018: 3 · 2017: 4
- FWCI
- 1.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obstetrical & Gynecological Survey (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Keywords
- abdominal wall endometriosis, endometrioma, cesarean section, postoperative endometriosis, pelvic surgery, surgical excision, recurrence, diagnostic imaging, ultrasound, magnetic resonance imaging, clinical guidelines
- MeSH terms
- Dissection, Endometriosis, Female, Humans, Medical History Taking, Physical Examination, Disease Management, Abdominal Wall
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