Caesarean scar endometriosis

Prospective study concerning 71 cases of caesarean scar endometriosis (CSE)

A prospective study was undertaken involving 71 patients with caesarean scar endometriosis (CSE) between the years 2007 and 2013. A prospective study enabled us to find out: mean age of patients with CSE; 34.0 years (range 22.0-48.0), time between CS and diagnosis of CSE; 12.0 months (range 19.0-39.0), duration between symptoms and surgery; 24.0 months (range 1.0-204.0), mean operation time; 40.0 min. (range 15.0-160.0), and mean lesion size; 54.4 ± 42.3 mm³. In three patients (4.2%) a large deficit in the abdominal wall was closed by means of polypropylene mesh. One of them conceived a year later. Surgical excision is the only effective treatment in patients with CSE. Wide local excision with clear margins is the key to prevent recurrence. Repair of large post-excisional deficits with mesh may also be offered to woman planning their next pregnancy. Impact statement • What is already known on this subject? Endometriosis in the scar may occur after various abdominal surgeries, more frequently after caesarean sections. The excision of large nodules is connected with suboptimal cosmetic outcomes and the possibility of recurrence. • What the results of this study add? In this study including 71 patients with CSE, wide excision with electrocoagulatory was associated with a single recurrence in 12-month follow-up. In three patients (4.2%) large deficits in the abdominal wall were closed with the use of polypropylene mesh. One of them conceived a year later and had a successful pregnancy. • What the implications are of these findings for clinical practice and/or futher research? Surgical excision is the only effective treatment in patients with CSE. Wide local excision with clear margins is the key to preventing recurrence. Repair of large post excisional deficit with mesh may be offered also to woman planning pregnancy.

The importance and perspective of magnetic resonance imaging in the evaluation of endometriosis

MR imaging is becoming increasingly important in the assessment of patients with endometriosis. Its multiplanar capabilities and superior soft tissue contrast are particularly useful in the detection of deep infiltrating endometriotic implants. Endometriosis, defined as the presence of endometrial glands and stroma outside the endometrium, is among the most common gynaecological disorders affecting women in their reproductive age. The diagnosis and evaluation of the extension of endometriosis are difficult only with physical examination and laparoscopy. According to the authors' personal experience, a special MRI technique and some imaging guidelines regarding different anatomical localizations of endometriosis are discussed. This review is a brief presentation of current evidence on the diagnostic accuracy of MRI in the evaluation of endometriosis concerning other diagnostic methods, the limitations of MRI and its essential usefulness for preoperative diagnosis of deep pelvic endometriosis, and future perspectives in monitoring this disease.

Chronic Umbilical Discharge: An unusual presentation of endometriosis

Umbilical endometriosis is an important differential diagnosis of any umbilical lesion. A 35-year-old type 2 diabetic woman presented with intermittent umbilical discharge which failed to respond to various antibiotics. An ultrasound scan and MRI scan failed to show any obvious abnormality. The umbilicus was excised and histology confirmed endometriosis. Surgical excision provides a definitive diagnosis and curative treatment for isolated endometriosis.

Fine-needle aspiration cytology of scar endometriosis: study of seven cases and literature review

Endometriosis is defined as the presence of endometrial-like glands and stroma outside the uterine endometrial lining. Endometrial tissue has also been identified in numerous surgical or procedure scars, including cesarean section and laparoscopic trocar tract. A prospective study was conducted at Maternidade-Escola Assis Chateaubriand, Faculty of Medicine, Federal University of Ceara, Brazil in seven patients with abdominal wall mass pathologically proven as scar endometriosis from January 2004 to December 2008. All cases were submitted to fine-needle aspiration cytology (FNAC). Age ranged from 21 to 42 years old (mean: 30) with parity ranging from 0 to 3 (mean: 1.4). The preceding history of pelvic procedures was miomectomy (1 of 7), cesarean section (3 of 7), and diagnostic laparoscopy (3 of 7). The complaints occurred about 18 months after the surgical proceeding. The FNAC findings were endometrial-like epithelial cells (6 of 7) and stromal cells (6 of 7); decidualization occurred in 2 of 7 cases. Hemosiderin-laden macrophages were present in all cases. FNAC is a fast and accurate method to make the diagnosis before the surgery, avoiding errors in the approach of the abdominal wall endometriosis' scars.

Endometriosis of the appendix: Report of three cases

Endometriosis of the appendix is an entity of extragonadal endometriosis. It commonly affects women in the childbearing age with a wide spectrum of clinical manifestations. Women can present with symptoms mimicking acute appendicitis or chronic pelvic pain. The surgical management varies from simple appendectomy to right hemicolectomy depending on the clinical findings. We report 3 cases of endometriosis of the appendix presenting with appendiceal intussusception. The surgical literature is reviewed and current surgical management is discussed.

Appearance of abdominal wall endometriosis on MR imaging

OBJECTIVE

Abdominal wall endometriosis (AWE) is defined as endometrial tissue that is superficial to the peritoneum. AWE is often difficult to diagnose, mimicking a broad spectrum of diseases. The aim of this study was to describe the appearance of AWE on magnetic resonance (MR) imaging.

METHODS

We present ten patients with AWE (12 lesions) in which MR imaging was used for diagnosis. MR imaging included T2-weighted imaging and T1-weighted imaging with fat suppression. To assess the value of diffusion-weighted imaging (DWI) in endometriosis, four patients underwent additional DWI. The apparent diffusion coefficient (ADC) was calculated using b values of 50, 400, 800 and 1,200 s/mm(2).

RESULTS

In most cases, the lesion was located ventral or dorsal to the aponeurosis of the rectus oblique muscle (n = 6) or in the rectus abdominis (n = 5). MR of AWE lesions showed isointense or slightly hyperintense signal compared with muscle on T2-weighted images and showed isointense or slightly hyperintense signal compared with muscle on T1-weighted images with foci of high signal intensity, indicative of haemorrhage. The mean ADC value of AWE was 0.93 x 10(-3)/mm(2)/s.

CONCLUSION

MR imaging seems to be useful in determining the location and depth of infiltration in surrounding tissue preoperatively.

Creation of a uterine scar endometrioma after uterine perforation at the time of a dilation and evacuation

Nonovarian endometriomas typically present as a slow-growing, painful abdominal mass in or around the site of a previous surgery. There can be considerable variation, however, because some masses grow rapidly and are not associated with pain whereas others cause patients significant discomfort and associated symptoms. The case of a 31-year-old woman, gravida 3 para 2, who had development of a uterine scar endometrioma after perforation during a dilation and evacuation, is examined. This is an unusual case considering the rate of uterine perforation at the time of gynecologic procedures and the lack of data related to the creation of nonovarian endometriomas.