Endometriosis of Rectus Muscle Excised During Cesarean Section: A Case Report and Literature Review (original) (raw)
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Rectus abdominis muscle endometriosis after cesarean section--case report
Acta Clinica Croatica, 2009
Endometriosis is defined by the presence of functional endometrial tissue outside the uterus, where it is normally located. Endometriosis is one of the most common gynecologic entities affecting 8%-18% of menstrual women. Endometriosis can occur at intra- and extrapelvic localizations. The most common intrapelvic localizations are those involving the ovaries, Douglas' area, pelvic peritoneum, uterus, bladder and rectum. Abdominal endometriosis is the most common localization of extrapelvic endometriosis and usually develops in connective tissue. Extra-pelvic implantation of endometrial tissue may develop in any organ including the skin, lungs, liver, extremities, brain and stomach. Three years after cesarean section, a 35-year-old female was operated on for suspected anterior abdominal hernia at the site of previous section. An egg-sized tumor was removed from the rectus abdominis muscle and referred for histopathologic and immunohistochemical analyses. The results showed endometriosis of the muscle with positive estrogen and progesterone receptors. A year after the procedure, treatment with gonadotropin-releasing hormone analogs was continued due to recurrent pain in the scar area, along with ultrasonography and biochemical marker (carbohydrate antigen 125) follow-up. Clinical diagnosis of scar endometriosis can be made by thorough history and physical, ultrasonography and biochemical examinations. Scar endometriosis should always be considered when the symptoms occur in a cyclic and hormone-dependent pattern, mostly after gynecologic operations, and worsening during menstruation. Definitive diagnosis is based on histopathologic analysis.
A Case of Endometriosis in the Abdominal Wall Post Caesarean Section
Surgical Science
We report the case of a 33 year old female who presented with endometriosis of the anterior abdominal wall following Caesarean Section at the surgical incision site. Abdominal Incisional Site Endometriosis can pose a diagnostic dilema owing to its relative rarity and vagueosity of symptoms, vis-a-vis, cyclical abdominal pain and occasional palpable mass associated with menstruation. A greater index of suspicion should be prompted in such patients especially if symptoms occur following pelvic surgery such as Caesarean Sections, hysterotomy, and myomectomy.
Journal of Endometriosis and Pelvic Pain Disorders, 2017
Introduction The aim of our study was to retrospectively learn about the incidence of abdominal wall endometriosis (AWE) after caesarean section (CS) in our Perinatal Centre (Perinatal Centre of the Institute for the Care of Mother and Child), one of the largest in the Czech Republic. Methods This is a retrospective review of hospital records on 18,454 caesarean deliveries between 2003 and 2014. Results A total of 17 cases of caesarean scar endometriosis (also known as AWE) were identified. The median age was 36.0 (33.5-43.5) years. In 10 patients, the cyclic pain was present. The median interval between CS and first symptoms was 3.0 (1.0-6.5) years. Ultrasound supported the diagnosis by the identification of hypoechogenic lesions in all patients. The median interval between symptoms development and surgical excision was 1.0 year (1.0-4.0 years). Excision was the mode of treatment. Excisions with clear margins (15 cases) were curative to all those patients. Two patients with involve...
Anterior Abdominal Wall Endometriosis Following Caesarean Section: Two Rare Cases
Parietal endometriosis is a rare clinical entity, whose pathophysiology remains unclear. It occurs most often after gynecological or obstetrical surgery. The clinical picture is relatively unspecific. Medical imaging is not very contributive. Only histological examination of the operative specimen can confirm the diagnosis. Surgical treatment must be wide enough to prevent recurrence. We report two cases of abdominal wall endometriosis occurring on cesarean section scar. Through these two cases, we will highlight the characteristics of this pathology including prognosis, which will help the practitioners in understanding the role of diagnosis and early management of this entity and its prevention during gynecological or obstetrical surgery.
Rectus abdominis muscle endometriosis Report of two cases and review of the literature
Annali italiani di chirurgia, 2012
Endometriosis involving the rectus abdominis muscle is very rare; until now, only 19 such cases have been reported in the medical literature since it was first described in 1984 by Amato and Levitt; almost all were associated with previous abdominal surgery such as cesarean section or other operations. We report two additional cases of this very rare condition presenting with an abdominal mass which was surgically excised with an accompanying margin of normal tissue. Both patients are well and without recurrence. Endometriosis pain has generally been described as cyclical and this condition usually develops in an old surgical scar. Endometriosis has no pathognomonic imaging findings on CT, MRI or sonography, as its appearance depends on the phase of the menstrual cycle, the proportion of stromal and glandular elements, the amount of bleeding and the degree of surrounding inflammatory and fibrotic response. Surgery is the treatment of choice including 5-10 mm of surrounding healthy t...
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.
Cesarean scar endometriosis: Presentation of eleven clinical cases and review of the literature
Journal of Turkish Society of Obstetric and Gynecology, 2011
Endometriosis is the presence of functioning endometrial tissue outside the uterine cavity. It can sometimes occur after obstetrical and gynecological surgeries. Scar endometriosis is rare and difficult to diagnose. This condition is often confused with other surgical patologies and preoperative diagnosis is rarely established. Medical treatment is not helpful. The patients required wide surgical excision of the lesion. In this study we are reporting eleven cases of abdominal wall endometriosis which were developed following cesarean section. The mean age of the patients was 28.3 and there were no any operation other than cesarean section. All masses were totally resected with one cm surgical margin. Whenever a female patient is presented with abdominal wall mass previous gynecological operations should be evaluated and endometriosis must be regarded between differential diagnosis.
Journal of Minimally Invasive Gynecology, 2009
We report 2 rare cases of endometriosis on the rectus abdominal muscle diagnosed incidentally during an operation for inguinal hernia repair in women with no surgical history. Two women sought medical attention for a mass found in the pubic abdominal wall. Only 1 woman reported occasional pain. At physical examination in both women, an ovoid swelling in the right pubic area was felt. One woman experienced pain on palpation, and one reported slight discomfort. Ultrasonography demonstrated a heterogeneous hypoechogenic formation with indistinct edges; diagnosis was difficult. Routine clinical and instrumental (pelvic ultrasonography) gynecologic examination in both patients performed shortly before hospitalization had not revealed any macroscopic focus of endometriosis in the pelvic region. At surgery, a lesion consistent with the diagnosis of endometriosis was found, which was confirmed at histologic analysis. These cases could represent the consolidation of different theories of endometriosis diffusion. We suggest including endometriosis in the differential diagnosis of a symptomatic mass in the abdominal wall in women with and without a surgical history.
Scar Endometriosis Following Cesarean Section
Gorm, 2012
OBJECTIVE: The purpose of our study was to evaluate clinical features of abdominal wall endometriosis following cesarean section. STUDY DESIGN: Our institution's database over a 5-year period was performed, yielding 9 surgically proven cases of abdominal wall endometriosis that were retrospectively studied. All patients had undergone sonography. The clinical data were analyzed. RESULTS: All patients had a history of at least one prior cesarean section. None of them had endometriosis history. All presented with focal pain near the surgical scar, which was cyclic in seven patients. Three patients presented with a palpable mass near the scar. Sonography detected all lesions within the abdominal wall, with a mean diameter of 30 mm. All lesions were vascular, and solid, with some cystic changes. CONCLUSION: Abdominal wall endometriosis frequently presents with cyclical pain during menstruation which is localised to a palpable mass in the abdominal wall especially in those who have ha...