The clinical characteristics and surgical approach of scar endometriosis: A case series of 14 women (original) (raw)
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Retrospective clinicopathological analysis of scar endometriosis and its surgical management
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Scar endometriosis is a rare form of extrapelvic endometriosis. It is defined as presence of endometrial glands and stroma in the abdominal wall. They have a variable clinical presentation and present to various doctors. Abdominal mass along with cyclical pain is pathognomic of scar endometriosis. Objective was to analyse the clinical presentation and surgical outcomes of scar endometriosis.Methods: It was a retrospective observational study. We have collected records of 28 patients of scar endometriosis managed at GEM Hospital over a period of 3 years. Patients demographic features, previous surgery, clinical findings, surgical findings, association with pelvic endometriosis as noted on diagnostic laparoscopy, need for mesh, recurrence rate on follow up were noted.Results: Mean age of patients was 32.1 years. History of previous caesarean surgery/hysterotomy was present in all patients. Major clinical presentation was cyclical pain. MRI or USG was done and abdominal wa...
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.
Scar endometriosis: not a rare cause for a painful scar: doi: 10.7417/CT.2021.2299
Clinica Terapeutica, 2021
Endometriosis is the presence of endometrial tissue outside the uterus 1. The incidence of endometriosis is unknown, but it is believed that 10-15% of all women in their reproductive age develop endometriosis and 25-35% of infertile women have endometriosis 2. Scar endometriosis (SE) is quite rare, its incidence develops in 1% of women following obstetric or gynaecological surgeries 3. Literature has been focused on the association between SE and caesarean section 4 , but SE may also due to previous Abstract Introduction. Endometriosis has been described as the presence of endometrial tissue outside uterine cavity. Scar endometriosis (SE) is a rare disease reported in 0.03-1.08% of women following gynaecologic surgery. In our retrospective observational cohort study we studied anamnesis, symptoms, surgical procedures and outcomes linked to scar endometriosis in our medical experience from 2004 to 2018. Methods. We reviewed the medical records of 46 patients with a histopathological diagnosis of SE. All patients had a history of at least one previous caesarean section (n=46, 100%). Forty-two patients (91,3%) complained gradually growing nodular abdominal mass near or adjacent to caesarean incision scar, while only 4 patients (8,6%) complained aspecific abdominal pain. Ultrasound scan was performed in all patients (n=46, 100%) and mean size of the nodules at US was 26,8 ± 13,8 mm. Results. All patients underwent surgery. Seven patients (15,2%) needed mesh implantation, while 39 patients (84,8%) underwent local resection with reconstruction of muscle fascia. Mean follow-up was 31,6 ± 14 months and no patients reported local recurrence of disease. Conclusion. high suspicion of scar endometriosis are painful nodule in the abdominal scar. Wide surgical excision is the treatment of choice.
Surgery Today, 2014
Endometriosis is a common disorder in females of reproductive age. Surgical scar endometrioma after cesarean section develops in 1-2 % of patients, and usually presents as a tender and painful abdominal wall mass. The diagnosis is suggested by pre or perimenstrual pelvic pain and is often established only by histology. In this retrospective observational cohort study, we reviewed the medical records of five patients with a histopathological diagnosis of scar endometriosis. A scar mass was found on a previous Pfannenstiel incision in four patients and in a median cesarean section in one patient. The mean age at diagnosis (38.6 years, median 38) was older than reported elsewhere. A histological examination of the surgical specimen confirmed the diagnosis of endometriosis in all cases. During the follow-up period (mean 34.6 months), local recurrence (n = 1) and pelvic recurrence (n = 1) were treated surgically. Surgery is the treatment of choice for surgical scar endometriosis. Excision with histologically proven free surgical margins of 1 cm is mandatory to prevent recurrence. As scar endometriosis may be associated with pelvic localization, explorative abdominal laparoscopy may be indicated to exclude the intraperitoneal spread of the disease in symptomatic patients.
Surgical Scar Endometiosis: A Series of 14 Patients and Brief Review of Literature
Clujul Medical, 2017
Background and aims. Endometriosis is a commonly found disorder in women of reproductive age, consisting in the presence of active ectopic endometrial tissue outside of the endometrial cavity. Surgical scar endometriosis is a rare condition representing about 2% of all endometriosis cases. The purpose of this study was to assess the main characteristics, diagnosis tools and therapeutic options in abdominal wall endometriosis (AWE). Methods. We have reviewed a series of fourteen cases with histopathological confirmation of AWE that were managed in our institution.Results. The main characteristic of AWE were emphasiszed, showing that 78.57% of the patients had at least one previous caesarian section and that in only 57.14% out of ol case an accurate diagnosis of AWE was established preoperatively. Conclusion. A direct relationship between gynecological and obstetrical surgery and AWE is well established and as the caesarian section rates increase constantly, the awareness regarding AW...
Scar endometriosis: not a rare cause for a painful scar
La Clinica terapeutica, 2021
Conclusion High suspicion of scar endometriosis are painful no-dule in the abdominal scar. Wide surgical excision is the treatment of choice. Introduction Endometriosis has been described as the presence of endometrial tissue outside uterine cavity. Scar endometriosis (SE) is a rare disease reported in 0.03-1.08% of women following gynaecologic surgery. In our retrospective observational cohort study we studied anamnesis, symptoms, surgical procedures and outcomes linked to scar endometriosis in our medical experience from 2004 to 2018. Methods We reviewed the medical records of 46 patients with a histopathological diagnosis of SE. All patients had a history of at least one previous caesarean section (n=46, 100%). Forty-two patients (91,3%) complained gradually growing nodular abdominal mass near or adjacent to caesarean incision scar, while only 4 patients (8,6%) complained aspecific abdominal pain. Ultrasound scan was performed in all patients (n=46, 100%) and mean size of the nod...
Indian Journal of Surgery, 2008
Background Abdominal scar endometriosis is an uncommon pathology. It can occur in any abdominal scar, most often after a surgical procedure on the uterus. Aim The purpose of this study is to highlight the potential pitfall in the diagnosis of this disease. Patients and methods This retrospective study reviewed all cases of proven abdominal scar endometriosis seen in a 5-year period (2002-2006) in our hospital, noting the demographic data of the patients and management. They were all treated by the same surgeon and also had histopathological confi rmation of the lesion. Results A total of 14 women were treated during this period. They were all pre-menopausal. The mean age was 29.1years (range 20 to 42). Presenting symptoms included painful 'heaped-up' scars and cyclical pain related to their menstrual periods. They were referred to the general surgical clinic with various diagnoses such as incisional hernia, granuloma, keloid scar etc. All the patients had history of previous surgical procedures on the uterus for various indications. Treatment was a wide excision of the lesion with apposition of the edges only. Specimens were examined histologically and confi rmed to be endometriosis. The follow up periods were rather short as the patients stopped to attend the hospital. During this period, there was no recurrence or wound breakdown. Conclusion Although scar endometriosis is a rare entity, a good and diligent surgical history and a high index of suspicion are the keys for a pre-operative diagnosis.
Scar endometriosis: an entity not to be forgotten
JPMA. The Journal of the Pakistan Medical Association, 2017
Scar endometriosis is an uncommon but well-described condition. It is caused by the dissemination of endometrial tissue in the wound at the time of surgery. The deposits can involve uterine scar, abdominal musculature or subcutaneous tissue, with the latter being the most common. It usually presents as a palpable mass at the scar site with or without cyclical pain. We report three cases of scar endometriosis which presented with cyclical pain and swelling at the abdominal wall scar following uterine surgery. The patients underwent imaging which revealed abnormal findings at the scar site suggesting scar endometriosis. In the presence of strong clinical suspicion and supportive imaging, all three of them underwent local excision of the lesion. The diagnosis of endometriosis was confirmed on histopathology.
Scar endometriosis in the abdominal wall: a predictable condition for experienced surgeons
Acta chirurgica Belgica
Endometriosis in surgical scars develops in 0.1% of those women who undergo Caesarean section or other obstetric surgery. Herein we analyse and discuss the clinico-pathological characteristics of 15 patients with scar endometriosis in the abdominal wall. Fifteen cases of scar endometriosis in the abdominal wall that were treated surgically in our department between 2003 and 2009 were examined retrospectively. Age, parity, complaint, medical or surgical history, pre/postoperative hormonotherapy, size of the mass, surgical procedure, follow-up and disease recurrence were analysed. This retrospective study included 15 patients presenting with 17 postoperative abdominal wall masses. The mean age of the patients was 32.1 +/- 6.0 years (range, 23-48). Eleven of the patients had a painful mass that became bigger before menstruation, two had palpable masses only, and two were hospitalised because of a mass with persistent pain. The locations of the masses were as follows: eight were close t...
266 SCAR ENDOMETRIOMA FOLLOWING CAESAREAN SURGERY .pdf
Objective:-1. To See the incidence of scar endometrioma in our gynaec outpatient clinic. 2. To identify the clinical pattern of the disease. 3. Incidence of symptomatic relief post resection. 4. Post resection need for medical therapy. Design and Setting:-Retrospective descriptive study of the etiology and prospective analysis of scar endometriosis and symptoms on pain scale, at Nice hospital of women, children & newborns at Shanthinagar Hyderabad, Telangana, India. Methods: -Data from the medical records of patients from OPD Clinics and IP Records during Jan 2013 to Oct 2016 with pre operative diagnosis of scar endometrioma who underwent surgery between 2013 to 2016 were survey and reviewed .Current data of confirmation of diagnosis by High-Resolution Ultrasound Scan and MRI and histopathological examination of respected mass. The main information surveyed was age, obstetric antecedents, symptoms, tumor location, size& palpation, duration of complaint, diagnosis, and treatment. All underwent tumor excision with a safety margin. Results: -There were 6 patients , a mean age 30.1+ 5.0yrs plus or minus (Range 18-40 yrs) 100% located in and around cesarean scars. The main symptom was localized cyclical pain (80-100%) of mean duration 20-24 months , the interval between LSCS and onset of Scar Endometrioma was between 3yrs to 7yrs. Surgical treatment was successful in all cases. Conclusion: -This is an uncommon disease. Most important a diagnostic criterion is a Cyclical pain at the local site during menstruation. Patient undergoing cesarean section is at the greatest risk. The surgical treatment of choice is excision of the endometrioma with a safety margin. Post-operatively medical therapy given in all cases. The patient is followed up every 6 months to assess any recurrence.