Painful endometrial implants to the abdominal wall: minimally invasive treatment with percutaneous cryoablation with laparoscopic assistance

In this case report, we describe a young woman presenting with long-standing severe abdominopelvic pain caused by abdominal wall endometrial implants. Due to the location, surgical resection was felt to be excessively morbid. Cryoablation entails the image-guided insertion of specialised needles into the tissue to induce tissue freezing and necrosis for the treatment of a variety of disease processes. However, percutaneous cryoablation was deemed impractical due to the implant's location and risk of injury to the bladder and bowel. Using a hybrid approach of laparoscopic dissection of the bowel and bladder away from the abdominal wall to allow concurrent ultrasound-guided cryoablation, the implant was successfully ablated. Once recovered, she had a resolution of pain. Cryoablation is an effective method to treat painful endometrial implants to the abdominal wall with minimal morbidity.