Risk Factors, Clinical Presentation and Outcomes for Abdominal Wall Endometriosis

Abstract Study Objective To evaluate risk factors, presentation and outcomes in cases of abdominal wall endometriosis. Design This is a case control study. Design Classification Canadian Task Force classification II-2 Setting Academic medical center Patients Total of 102 (34 cases and 68 controls) were included. Intervention(s) Surgical resection of abdominal wall endometriosis. Main Outcome Measure(s) Cases underwent surgical excision for abdominal wall endometriosis at Mayo Clinic from January 1, 2000 through December 31, 2013. For each case, 2 controls were randomly selected from a list of women who had surgery in the same year with minimal (ASRM stage I-II) endometriosis. Chart review was completed for variables of interest. Regression models were utilized to identify independent risk factors associated with abdominal wall endometriosis. Result(s) In 14 years, 2,539 women had surgery for endometriosis at Mayo Clinic. Of these only 34 (1.34 %) had abdominal wall endometriosis. The mean age was 35.2 ± 5.9 years and median parity was 2 (range 0-5). Clinical exam diagnosed abdominal wall endometriosis in 41% of cases with cesarean delivery scar being the most common site (59%). There was strong correlation between the size of lesion on clinical examination compared to size of pathology specimen (r2 =0.74, P < 0.001). When compared to controls, cases had significantly higher parity and body mass index, more cyclic localized abdominal pain, less dysmenorrhea, longer duration from start of symptoms to surgery and more gynecologic surgeries for symptoms without cure. In the final multivariable model, cyclic localized abdominal pain, absence of dysmenorrhea, and previous laparotomy were independently associated with abdominal wall endometriosis with adjusted odds ratios of: 10.6 (1.85-104.4, P < 0.001), 12.4 (1.64 - 147.1, P < 0.001) and 70.1 (14.8 - 597.7, P < 0.001), respectively with an AUC for ROC of 0.94 (95%CI 0.87 - 0.98). After excision of the disease, repeat surgery was needed in 2 (5.9%) patients with a median time to recurrence of 50.5 (36-65) months. Conclusion(s) Abdominal wall endometriosis is a rare but unique form of endometriosis. Careful history and clinical exam can provide accurate diagnosis and avoid unnecessary delay before surgical intervention. Localized cyclic abdominal pain with absence of dysmenorrhea and a history of prior laparotomy are independent risk factors with very high accuracy for diagnosis.