Endometriosis is a very common gynaecological disease, although the abdominal wall localization is a rare clinical problem in the everyday practise and this explains the incomplete reports in literature and the difficulty of a standard treatment. Authors report four abdominal wall endometriosis cases, underlining how the surgical therapy represents the gold and decisive treatment, thanks also to prosthetic reconstruction techniques who allow more radical demolitions. On the contrary, the medical treatment should be reserved to selected cases such as especially the less symptomatic umbilical primitive diseases.