76 Hellenic Journal of Surgery 2012; 84: 1 Abstract Endometriosis is a common gynaecological condi- tion which affects women during their reproductive years. It is characterized by ectopic endometrial tissue responding to hormonal changes associated with menstrual cycle. Aetiology is unknown and symptoms are quite aspecific (dysmenorrhoea, pelvic pain, infertility or pelvic mass). Ηere we report the case of a 43-year-old woman, who pre- sented with complaints of chronic abdominal wall pain and lower abdominal discomfort during men- struation. Symptoms persisted for more than nine months. Clinical and ultrasound evaluation raised the suspicion of abdominal wall endometriosis; sur- gical exploration confirmed diagnosis. The patient progressed satisfactorily and is free of symptoms 20 months after surgery. Abbreviations: Chronic abdominal wall pain (CAWP), abdominal wall endometriosis (AWE), computed tomography (CT), magnetic resonance imaging (MRI). Key words: Endometriosis, Chronic abdominal wall pain Introduction Chronic abdominal wall pain (CAWP) originat- ing from the abdominal wall is moderate to sharp and there is usually tenderness upon gentle strok- ing or pinching in that area of the skin. It is often misdiagnosed as arising from a source inside the ab- dominal cavity, which often results in inappropriate diagnostic investigations, unsatisfactory treatment, and considerable costs [1]. The aetiology is usually simple in origin and remains unknown until surgical intervention reveals the cause, at which stage rap- S. V. Kontostolis, A. Vitsas, E. Boultadakis, P. G. Sfikakis (Corresponding author) - 2 nd Surgical Department, “Tzaneion” General Hospital, Piraeus, Greece K. Stamatiou - Urology Department, “Tzaneion” General Hospital, Piraeus, Greece e-mail: pgsfikakis@yahoo.com id diagnosis and surgery is required [2]. The most usual cause of CAWP is entrapment of a branch of one of the lower thoracic intercostal nerves in the abdominal wall muscle. Other diseases affecting the nerves, such as diabetes, herpes zoster, trauma and rarely, cancer, may also cause symptoms of CAWP [1]. Occasionally, abdominal wall haematomas, her- nias and painful rib may account for abdominal wall pain [3]. Abdominal wall endometriosis (AWE) is an extremely rare cause of CAWP, accounting for less than 1% of the cases [2]. Ηere we report the case of a 43-year-old woman, who presented with complaints of chronic abdomi- nal wall pain and lower abdominal discomfort dur- ing menstruation. Apropos to this interesting case, we discuss the pathogenesis, presentation and treat- ment options of this enigmatic disease. Case Presentation A 43-year-old woman presented to the outpatient department, complaining of CAWP and lower ab- dominal discomfort during menstruation. Symp- toms had persisted for more than nine months. One year previous, she had undergone a caesarean sec- tion for delivery of her first child. She also reported a history of hypothyroidism and gastroesophageal reflux disease. From the gynaecological history, we noted that the patient had regular, painless men- strual cycles. At admission, the physical examina- tion revealed a painful swelling at the scar site of the recent caesarean section. The mass was immobile, sensitive to the touch, adherent to the skin, with firm consistency. Ultrasound examination revealed an anisoechogenic nodule and small hypoechoic areas enclosed in an area with hyperechogenicity, with a diffuse contour. Both clinical and ultrasound evaluation raised the suspicion of abdominal wall endometriosis. and surgical exploration was per- formed. A dense, fibrous, structure was identified, which was removed entirely, along with healthy sur- rounding tissue. Foci of endometriosis mixed with collagen fibres detected upon microscopic examina- tion confirmed the diagnosis of parietal endometri- osis. The patient progressed satisfactorily and is free Endometriosis of the Abdominal Wall. Α Rare, Under-Recog- nized Entity Causing Chronic Abdominal Wall Pain S. V. Kontostolis, A. Vitsas, E. Boultadakis, K. Stamatiou, P. G. Sfikakis Received 16/09/2011 Accepted 19/10/2011 Case Report Surgery οf Colon Cancer in a District Hospital 76