Abdominal Scar Endometrioma Mimicking Incisional Hernia: A Diagnostic Pitfall (original) (raw)
Related papers
Abdominal scar endometriosis: case report
Clinical and Experimental Obstetrics & Gynecology, 2016
Abdominal scar endometriosis, corresponding to the presence of an endometrial tissue near or inside an abdominal surgical incision, is a rare clinical event that can occur in women after gynecological or obstetric surgery. Generally, a triad consisting of underlying mass at the incision, cyclic menstrual scar pain, and history of previous gynecological or obstetric surgery leads to the preoperative diagnosis. In rare cases, the clinical presentation is atypical and the differential diagnosis with incarcerated incisional hernia, granuloma, abscess or other soft tissue tumors can be difficult. The authors describe the case of 39-year-old woman who underwent three previous cesarean sections, with a 20-week history of underlying palpable mass at the Pfannenstiel incision, associated to continuous pain. In this case, a surgical excision followed by the histology definitely clarified the diagnosis.
Volume 11, Number 4, Jan-Mar 2018
leading cause of chronic pelvic pain and infertility, its clinical presentation can vary, resulting in diagnostic and thera-conditions. Endometrial tissue in a surgical scar is uncommon and often misdiagnosed as a granuloma, abscess, or malignancy. Cyclical hemorrhagic ascites due to peritoneal endometriosis is exceptionally rare. We report the case of a pre-menopausal, nulliparous 44-year-old woman who presented with ascites and a large abdominal mass that arose from the site of a lower midline laparotomy scar. Five years previously, she had undergone open myomectomy for drainage on multiple occasions. We performed a laparotomy with excision of the abdominal wall mass through an inverted T incision. The extra-abdominal mass consisted of mixed cystic and solid components, and weighed 1.52 kg. It communicated with the abdominopelvic cavity through a 2 cm defect in the linea alba. The abdomen contained a with no evidence of malignant transformation. The patient recovered well post-operatively and has remained asymp-tomatic. Our case illustrates that, despite being a common disease, endometriosis can masquerade as several other conditions and be missed or diagnosed late. Delay in diagnosis will not only prolong symptoms but can also compromise reproductive lifespan. It is therefore paramount that endometriosis is to be considered early in the management of premenopausal women who present with an irregular pelvic mass or hemorrhagic ascites.
Incisional endometriosis: a report of 3 cases
Canadian journal of surgery. Journal canadien de chirurgie, 2009
Incisional endometriosis: a report of 3 cases E ndometriosis is defined as a growth of ectopic endometrial tissue outside the uterine cavity that responds to hormonal stimulation. It occurs most commonly in pelvic sites such as the ovaries, posterior cul-de-sac, ligaments of the uterus, pelvic peritoneum and rectovaginal septum and is found in 8%-15% of all menstruating women. Extrapelvic endometriosis is less common but can affect many sites, including the lungs, appendix, nose, umblicus, peritoneum and even the intestinal wall. 1 The most common extrapelvic form of endometriosis is cutaneous endometriosis, mainly in scars following obstetric or gynecologic surgery. 2 Surgical scar endometriosis following cesarean section has an incidence of 0.03%-0.4%. 3 Because it is often mistaken for a suture granuloma, incisional hernia, lipoma, abscess, cyst or a strange body, diagnosis of this disease is not easy. However, a mass in a cesarean section scar with symptoms of cyclic pain related to menses is nearly pathognomonic. We report the cases of 3 women, aged 32, 22 and 30 years, respectively, who presented with a painful abdominal wall mass.
Incision scar’s endometriosis case that was treated with false diagnosis
European Journal of Therapeutics, 2017
Endometriosis is defined as the placement of a functional endometrium tissue outside the uterine cavity. Abdominal-wall endometriosis is usually observed after obstetric and gynecological operations. Endometriosis masses located in incision scars can be confused with foreign body reaction, granulomas, abscess, and incisional hernia. A 45-year-old female patient, who had undergone cesarean section 14 years ago, presented to our clinic for pain on the left side of the incision for 6 months and particularly because of the painful mass that grew during menstruation in that region. The patient was misdiagnosed as reactive lymphadenopathy due to fungal and bacterial infections in her toes before presenting to our clinic, and she was treated for a long time with this false diagnosis. On the left side of the Pfannen-Stiel incision, a non-mobile, painful mass of about 2×1 cm, with moderate stiffness, was detected on the physiological examination of the patient. Superficial ultrasonography applied to the region showed lobulated contour, mild heterogeneous hypoechoic, and mild vascularized solid lesion sized 10.4×3.4×10 mm on the left side of the incision line. The patient underwent surgery with an initial diagnosis of endometriosis in the incision scar. The received tissue was sent for pathological examination, and she was diagnosed as endometriosis. Thus, if a mass is detected in the anterior wall of the abdomen in women who had undergone cesarean delivery, the possibility of endometriosis should not be overlooked after the patient's history has been cautiously taken and physical examination and radiological examinations have been performed.
Scar endometrioma following surgical incision: A retrospective study
Military Medical
Abdominal wall endometrioma is a rare condition, which usually develops in a surgical scar of cesarean section or hysterectomy. The incidence of scar endometrioma ranges from 0,03 to 3,5%. Making the correct diagnosis before the treatment is not always possible. The surgery is difficult. The aim of this study is to discuss the features of 10 scar endometrioma cases in the light of the literature. Design and setting: In Ý stanbul GATA Haydarpaþa Training Hospital, Ý stanbul Zeynep Kamil Maternity Hospital and Erzurum Marasal Cakmak Millitary Hospital Gynecology and Delivery Clinics the records of 10 cases were identified and retrospectively surveyed. Methods: Ten cases with the diagnosis of scar endometrioma were operated and definitive diagnosis was confirmed by the pathological examination. The records were retrospectively surveyed. The patient ages, obstetric antecedents, delivery with prior cesarean section, symptoms, the size and localization of tumoral mass and the duration of complaints were surveyed and recorded. Results: Ten patients were included in the study. The mean ages of these patients were 30,5 years (range: 24-48 years). All patients had cesarean sections except only one. One patient had three vaginal deliveries and a hysterectomy operation which was performed a year ago. All of the scar endometria cases were observed on the transverse incision line of the lower segment. The mean tumor size was 19,5 cm3(range: 8-36 cm3). The main symptom was localized cyclical pain (100%), of mean duration 11,5 months (Range: 2-27 months). Asymptomatic period (the time interval between the obstetric procedure and the onset of symptoms) was mean 36 months in all patients.(Range: 10-72 months). Surgical treatment was successful in all cases. Conclusions: Abdominal wall endometriosis may be sometimes difficult to diagnose. The entire tumor with the healty tissue must be removed without causing the rupture in surgery. The patients must be definitively followed up postoperatively for recurrence.
Endometriomas: Two Case Reports and Review of Literature
2014
Objective: Scar endometriosis may develop after pelvic operations, such as cesarean section, tubal ligation, hysterectomy, hysterotomy or secondary to obstetric or surgical trauma. Perineal endometriosis in episiotomy scar and endometriosis in post hysterectomy abdominal scar endometriosis are quite rare. This prompted us to demonstrate the proper diagnosis; management and prophylactic procedure of scar endometriosis. Study Design: In these case reports we present females of age 27 and 38 years with complaints of growth at episiotomy site and post hysterectomy abdominal scar since 2 and 1 years respectively. In first case there is previous history of normal delivery 4 years back with episiotomy. The mass was increasing in size with pain and itching over the area during menses. A diagnosis of ?foreign body granuloma, ?endometriosis was done. In second case there was history of abdominal hysterectomy 2 years back. The patient presented with subcutaneous lesion on the anterior abdomina...