Abstract
Abdominal wall endometriosis (AWE) is a rare condition representing 1% of patients
operated for endometriosis. We describe a case of a 26-year-old woman, with a history
of cesarean delivery, who presented with cyclical pain and a subcutaneous mass in
the lower abdomen. Where most AWE lesions may be surgically managed by a single surgeon,
imaging revealed an unusually large lesion (13 × 4 × 10 cm) involving the rectus abdominis
muscle. Plastic, gynecologic, and general surgeons combined their expertise to conduct
AWE excision combined with miniabdominoplasty in a single procedure. After resection,
a retrorectus mesh (Rives–Stoppa technique) reinforced the primarily closed posterior
rectus sheath and an inlay mesh bridged the defect left in the anterior rectus sheath.
The patient was discharged 3 days postoperatively, had minimal pain complaints, and
was satisfied with cosmetic results at 1-month and later follow ups. One year postoperatively,
she gave uncomplicated vaginal birth. We conclude that, in select cases, management
of a large, symptomatic AWE may benefit from a multidisciplinary approach, where symptom
relief and an aesthetically pleasing result for the patient can be achieved in a single
procedure. We distinctively describe double mesh repair as a viable consideration
for reconstruction in AWE and review current considerations in mesh repair of the
abdominal wall. Further studies into this topic are warranted.
Keywords
surgery - plastic - abdominoplasty - endometriosis - surgical mesh - abdominal wall
