Abdominal Scar Endometrioma Mimicking Incisional Hernia: A Diagnostic Pitfall

Objective: Abdominal scar endometriosis is a recognized condition that has been described following a wide vari- ety of gynaecological procedures. We report a case of endometrioma, presenting as a painful subumbilical swelling, mimicking an incarcerated incisional hernia. Clinical Presentation: A 35-year-old woman presented with a painful subumbilical swelling that had been present for 6 months, but had increased in size and become more painful the day prior to admission. Her past medical history included four caesarean sections. Physical examination revealed a firm, tender and irredu- cible subumbilical nodule with no cough impulses, mim- icking a small incarcerated incisional hernia. Interven- tion: Exploratory laparotomy through the same lower midline incision revealed a subcutaneous swelling re- sembling an organized chocolate cyst of endometriosis. Apart from intra-abdominal adhesions, no connection to intra-abdominal structures was identified. Histopatholo- gy of the specimen was consistent with abdominal scar endometriosis. Conclusion: Endometrioma was diag- nosed in this 35-year-old woman following histological examination of a specimen removed during laparotomy. It is recommended that endometrioma should be consid- ered in the differential diagnosis of subcutaneous, scar- related hernias and various abdominal wall masses fol- lowing gynaecological operations.