A Case of Abdominal Wall Endometriosis Mimicking Strangulated Incisional Hernia (original) (raw)
Related papers
Abdominal Wall Endometriosis: Purpose of a Case and Review of Literature
Journal of Gynecology and Obstetrics, 2020
Endometriosis of the abdominal wall is defined as the presence of superficial ectopic endometrial tissue to the parietal peritoneum, whose origin may be associated with previous gynecological surgical procedures. Its prevalence is low, around 0.03%, being the first isolated case in our institution, its report and bibliographic review was necessary. The following paper is a case report and a brief bibliographic literature review. Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity. The definition includes injuries that may or may not be related to previous surgical procedures. It is associated with cesarean section in 57% and hysterectomy in 17%. We present the case of a 37 years old female patient, with a history of three previous cesarean sections 3, 6 and 10 years ago; who presented a clinical picture of a sensation of a mass in the abdominal wall, accompanied by cyclical pain and mass growth related to menstrual periods. Abdominal ultrasound reported a heterogeneous vascularized 4x5cm mass. She underwent surgery at our institution where an endometrial mass was evidenced that infiltrated the rectus abdominis, later the diagnosis was confirmed with the histopathological study. Abdominal endometriosis is a rare entity in medical practice. A high index of suspicion should be considered in the case of a woman who presents with disabling abdominal pain located in the abdominal wall, with a history of previous gynecological surgical procedures. This pathology can be confused with many other surgical entities; for this reason, resorting to paraclinical studies can be essential in the diagnostic certainty.
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.
[Abdominal wall endometriosis: case report]
Revista de la Facultad de Ciencias Médicas (Córdoba, Argentina), 2004
Endometriosis is defined as the presence of endometrial glands and stroma outside uterus. This ectopic finding occur in the abdominal wall among 0,03% to 1% of women with prior gynecologic surgery, particularly after cesarean section. Most frequently, endometriosis is present as a palpable mass, painfull during menstrual period, near surgical scar. It could mimic other pathologies such as hematomas, granulomas, inicisional hernias, abscesses and tumors. We report the case of a 35 years old woman with a painful mass during menstruation nearly cesarean scar. The tumor was completely removed and a polipropylen mesh was placed to repair the abdominal wall defect. It was identified as endometriosis in the anatomo-patologic examination.
Abdominal Scar Endometrioma Mimicking Incisional Hernia: A Diagnostic Pitfall
Medical Principles and Practice, 2001
Objective: Abdominal scar endometriosis is a recognized condition that has been described following a wide variety of gynaecological procedures. We report a case of endometrioma, presenting as a painful subumbilical swelling, mimicking an incarcerated incisional hernia. Clinical Presentation: A 35-year-old woman presented with a painful subumbilical swelling that had been present for 6 months, but had increased in size and become more painful the day prior to admission. Her past medical history included four caesarean sections. Physical examination revealed a firm, tender and irreducible subumbilical nodule with no cough impulses, mimicking a small incarcerated incisional hernia. Intervention: Exploratory laparotomy through the same lower midline incision revealed a subcutaneous swelling resembling an organized chocolate cyst of endometriosis. Apart from intra-abdominal adhesions, no connection to intra-abdominal structures was identified. Histopathology of the specimen was consiste...
Endometriosis externa within the rectus abdominis muscle
Turkish Journal of Surgery, 2014
The presence of endometrial glands and stroma outside the uterine cavity is called "endometriosis". Recklinghausen first defined this entity in 1896, and Sampson first named it in detail in 1921. Endometriosis is most often seen in the pelvis. Although extrapelvic endometriosis is rare, it can be seen in almost every organ. Endometriosis localized in the rectus abdominis muscle is very rare. A patient who had two previous cesarean sections presented with a 23 mm heterogeneous hypoechoic mass within the rectus abdominis muscle, approximately 1 cm superior to the Pfannenstiel incision that was diagnosed as endometriosis externa by fine-needle biopsy and excisional biopsy. Herein, we report this patient along with the literature.
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.
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.
Abdominal wall endometriosis: an update in clinical, imagistic features, and management options
Medical Ultrasonography, 2017
Abdominal wall endometriosis (AWE) is a rare condition defined by the presence of endometrial tissue in the subcutaneous fatty layer and the muscles of the abdominal wall. It is usually caused by the dissemination of endometrial tissue in the wound at the time of obstetrical and gynecological surgeries. AWE is rare and difficult to diagnose. The most frequent clinical presentation is that of a palpable subcutaneous mass near surgical scars associated with cyclic pain and swelling during menses. AWE may be an underreported pathology partly because it has scarcely received attention in the radiologic literature. Its frequency is expected to rise along with the increasing rate of cesarean deliveries; thus, it is important that physicians or sonographers are familiar with this pathology. The purpose of our review is to present the latest data regarding risk factors, clinical and imagisticfindings, and management of AWE.