Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases (original) (raw)
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Bosnian journal of basic medical sciences, 2017
Abdominal wall endometriosis (AWE) is a rare form of endometriosis that usually develops in the scar after cesarean section (CS). Recently, the occurrence of AWE has been increasing together with the increase of CS incidence. AWE can be clinically misdiagnosed as hernia, lipoma, or hematoma. Here we retrospectively analyzed the clinical aspects of AWE and surgical approach in 14 patients from a tertiary hospital, who were treated by surgery, between 2012 and 2017. The mean age was 32.71 ± 8.61 years (range: 19-45). Palpable mass and cyclic pain at the scar site were the most common complaints. Twelve patients had previously undergone CS, and two patients had undergone a surgery of ovarian endometrioma. The preoperative diagnosis was determined with ultrasonography (US), magnetic resonance imaging (MRI), or computed tomography (CT). Preoperatively, AWE was diagnosed in 12/14 patients (85.7%), while two patients (14.3%) were diagnosed with inguinal hernia. The treatment was surgical e...
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.
Abdominal wall endometriosis: accuracy of the diagnostic triad
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2015
Background: Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity and musculature. The objectives were to study the prevalence, the clinic-pathological presentation and the accuracy of the criteria for diagnosis of abdominal wall endometriosis. Methods: This is a retrospective observational study done at a tertiary hospital. The study was approved by the ethics committee and the IRB. Data was retrieved from computer generated medical records. Specificity, sensitivity and likelihood ratio along with univariate and multivariable penalized logistic regression analysis of each presenting symptom were done. Results: Of the 493 cases with genital endometriosis, 45 cases had AWE diagnosed clinically giving a prevalence of 8.3%. Histological diagnosis of AWE was made in 41, while 4 had suture granuloma. Pain, swelling and previous LSCS had sensitivity of 71%, specificity of 100% and the likelihood ratio was 0.29. The presentation was within 6 years after the index surgery of Caesarean section, with the odds ratio of having endometriosis of 19 (95% CI 1.7-1595) and the P value of 0.016. Conclusions: The diagnostic triad of previous caesarian section with swelling and pain at the scar site should prompt the possibility of AWE. However, previous LSCS was the only factor that contributed to the presence of abdominal wall endometriosis.
Abdominal Wall Endometriosis: A Diagnostic Dilemma for Surgeons
Medical Principles and Practice, 2005
were discharged from hospital on either the 2nd or the 3rd postoperative day uneventfully, and during followup there were no signs of pelvic endometriosis, as confi rmed by ultrasonography, CA 125 measurement, gynecological consultation and examination. Conclusion: Since the diagnosis of scar endometrioma is rarely established prior to surgery, endometriosis should be included in the differential diagnosis of masses on the abdominal wall.
[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 wall endometriosis. An overlooked diagnosis
Saudi medical journal, 2003
To study the incidence of abdominal wall endometriosis after cesarean section and its presentation to the general surgeon. Fourteen patients were treated for abdominal wall endometriosis during the period June 1997 to May 2002 at Princess Basma Teaching Hospital and King Abdulla University Hospital, Irbid, Jordan. The patient's files were reviewed to see their way and time of presentation after cesarean section, provisional diagnosis made and operative procedures performed. Symptoms suggestive of and investigations carried out to detect pelvic endometriosis were also looked for and recorded. Fourteen patients were treated within 5 years; all had painful scar-related mass. The pain was exacerbating during menstruation in 5. The clinical diagnosis was stitch granuloma in 3; incisional hernia in 3, abdominal wall tumor in 3 and abdominal wall endometrioma in 5 patients. The mean time for the mass to be noticed by the patient was 2 years. They were treated with wide local excision. ...
Abdominal wall endometriosis (a narrative review)
International Journal of Medical Sciences
One of the rarest forms of endometriosis is abdominal wall endometriosis (AWE), which includes caesarean scar endometriosis. AWE remains a challenging condition because some issues related to this topic are still under debate. The increasing number of caesarean sections and laparotomies will expect to increase the rate of AWE. The current incidence in obstetrical and gynaecological procedures is still unknown. The disease is probably underestimated. The pathogenic mechanism involves local environment at the implant site including local inflammation and metalloproteinases activation due to local growth factors, estrogen stimulation through estrogen receptors and potential epigenetic changes. However, the underlying mechanisms are not fully explained, and we need more experimental models to understand them. The clinical presentation is heterogeneous; the patient may be seen by a gynaecologist, an endocrinologist, a general surgeon, an imaging specialist, or even an oncologist. No particular constellation of clinical risk factors has been identified, and the histological report is the major diagnostic tool for confirmation. Surgery is the first line of therapy. Further on we need protocols for multidisciplinary investigations and approaches.
Abdominal wall endometriosis; A Case Report
2010
Abdominal wall endometriosis has an incidence of 0.3-1% of extrapelvic disease. A 48-year-old female appeared in the emergency department with cellulitis in a lower midline incision. She had an endometrioma of the anterior abdominal wall removed 2 years ago. After 5 months, she underwent an open repair of an incisional hernia with a propylene mesh, which was unfortunately infected and removed 1 month later. Finally, in July 2019, she had her incisional hernia repaired with a biological mesh. Imaging modalities revealed a large mass below the umbilicus. Mass was punctured under ultrasound guidance. Cytology reported the recurrence of endometriosis. Pain and abdominal mass associating with menses were the two most typical symptoms. Wide local excision of the mass with at least 1 cm negative margins is the preferred treatment. Surgeons should maintain a high suspicion of the disease in reproductive women with circular pain, palpable abdominal mass and history of uterine-relating surgery.
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...