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Kim SJ, Choi SH, Won S, Shim S, Lee N, Kim M, Kim MK, Seong SJ, Kim ML. Cumulative Recurrence Rate and Risk Factors for Recurrent Abdominal Wall Endometriosis after Surgical Treatment in a Single Institution. Yonsei Med J 2022; 63:446-451. [PMID: 35512747 PMCID: PMC9086694 DOI: 10.3349/ymj.2022.63.5.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aimed to evaluate the cumulative recurrence rate and risk factors for recurrent abdominal wall endometriosis (AWE) after surgical treatment. MATERIALS AND METHODS A retrospective cohort study was conducted at a single gynecological surgery center between January 2004 and December 2020. Patients who were surgically treated and followed up for at least 6 months after surgery were selected. RESULTS Eighteen patients with pathologically diagnosed AWE were included in this study. The median follow-up duration was 22.5 months (range, 6-106). The median age was 37 years (range, 22-48), and 33.3% of the patients were nulliparous. Among the patients included in our study, 55.6% complained of a mass with cyclic pain, and 27.8% had a palpable mass. In addition, 22.2% of patients experienced recurrence with 17.5±9.7 months of mean time to recurrence. The cumulative recurrence rates at 24 and 60 months after surgical treatment of AWE were 23.8% and 39.1%, respectively. There were no statistically significant risk factors for the recurrence of AWE, including postoperative medical treatment. CONCLUSION The recurrence rate of AWE appears to be correlated with the follow-up duration. There was no statistically significant risk factor for the recurrence of AWE. Unlike ovarian endometriosis, postoperative hormonal treatment does not seem to lower the recurrence of AWE. The findings of the current study may help healthcare providers in counselling and managing patients with AWE.
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Affiliation(s)
- Su Jin Kim
- Department of Obstetrics and Gynecology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Su Hyeon Choi
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Seyeon Won
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Sohyun Shim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Nara Lee
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Miseon Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Mi Kyoung Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Mi-La Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea.
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Figuier C, Montoriol PF, Pereira B, Chauvet P, Bourdel N, Canis M. Abdominal wall endometriosis: Is structure in imaging related to nodule localisation? A retrospective study. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2021. [DOI: 10.1177/22840265211009643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Investigate the relationship between the structure of abdominal wall endometriotic nodules in MRI and their localisation in abdominal wall layers in order to better understand nodule origins. Design: Women who had an MRI prior to surgical treatment of an abdominal wall endometriotic nodule between 2005 and 2016. Population: Thirty-six patients including four patients with two nodules. Methods: MRI images were reviewed. Each nodule was analysed according to its structure (fibrous, cystic, mixed), localisation (subcutaneous fat, intra muscular, intermediary position), and size. Results: Forty nodules were analysed in MRI with no relationship found between localisation and nodule structure ( p = 0.48). 87.5% of mixed nodules were revealed to have a cystic superficial rim extending towards the subcutaneous fat layer. This finding suggests that the glandular part of the nodule is the active part of the disease from which nodule progression occurs. Intermediary and intramuscular nodules were respectively statistically larger than subcutaneous fat nodules indicating a relationship between nodule size and localisation (35 mm (22–53) vs 17 mm (17–23)) ( p = 0.03). Conclusion: Despite differences in environments surrounding the nodules, no significant relationship between nodule structure in imaging and abdominal wall localisation was found. Data from mixed nodules indicate however the possible role of nodule environment on structure and that the mechanism of nodule growth may be linked to development of cystic superficial rims, at the forefront of disease progression, abdominal wall nodules growing from deep to superficial. Studies are required to further investigate our findings and enable greater understanding of the origins of AWE.
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Affiliation(s)
- Claire Figuier
- Department of Gynecological Surgery, Clermont Ferrand University Hospital, Clermont Ferrand, France
| | | | - Bruno Pereira
- Department of Clinic Research and Innovation, Clermont-Ferrand University Hospital, Clermont Ferrand, France
| | - Pauline Chauvet
- Department of Gynecological Surgery, Clermont Ferrand University Hospital, Clermont Ferrand, France
| | - Nicolas Bourdel
- Department of Gynecological Surgery, Clermont Ferrand University Hospital, Clermont Ferrand, France
| | - Michel Canis
- Department of Gynecological Surgery, Clermont Ferrand University Hospital, Clermont Ferrand, France
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Edwards K, Tsai SH, Kothari A. Clinical and imaging features of abdominal wall endometriomas. Australas J Ultrasound Med 2018; 21:24-28. [DOI: 10.1002/ajum.12076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kylie Edwards
- Bundaberg Hospital; 271 Bourbong Street Bundaberg Queensland 4670 Australia
- The University of Queensland; St Lucia Queensland 4072 Australia
| | - Shih-Han Tsai
- Redcliffe Hospital; Anzac Avenue Redcliffe Queensland 4020 Australia
| | - Alka Kothari
- The University of Queensland; St Lucia Queensland 4072 Australia
- Redcliffe Hospital; Anzac Avenue Redcliffe Queensland 4020 Australia
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Gachabayov M, Horta R, Afanasyev D, Gilyazov T. Abdominal wall endometrioma: Our experience in Vladimir, Russia. Niger Med J 2016; 57:329-333. [PMID: 27942100 PMCID: PMC5126745 DOI: 10.4103/0300-1652.193858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Endometriosis is defined as an estrogen-dependent, benign inflammatory disease characterized by the presence of ectopic endometrial implants. Abdominal wall endometrioma (AWE) being a rare entity is a benign tumor defined as ectopic functional, endometrial tissue located in the abdominal wall. Subjects and Methods: A retrospective study of 23 female patients treated with AWE in four departments of three centers in Vladimir city, Russia, from January 2010 to December 2014 was performed. Results: In twenty patients (87%), AWE was symptomatic, and in three patients (13%), AWE was asymptomatic. Esquivel triad presented in 17 patients (74%), and modified Esquivel triad existed in 20 patients (87%). All 23 patients were operated, and AWE excision was performed. Recurrence occurred in 4 cases (17.4%) and was associated with postoperative pain and seroma. Conclusion: Postoperative pain for more than 7 days and seroma (on ultrasonography) seem to be associated with recurrence of AWE.
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Affiliation(s)
- Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Roman Horta
- Department of Gynecology, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Dmitriy Afanasyev
- Ambulatory Surgery Center, Vladimir City Clinical Hospital No. 5, Vladimir, Russia
| | - Timur Gilyazov
- Department of General Surgery, Oblast Clinical Hospital, Vladimir, Russia
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Abstract
Purpose To investigate the association rate between abdominal wall and pelvic endometriosis in a population of Iranian patients, in University and private hospitals of Shiraz University of Medical Sciences. Methods 30 women were diagnosed as abdominal wall endometriosis according to the clinical signs and symptoms (dysmenorrhea, dyspauronia and pelvic pain) and the sonographic findings. The mean age of the patients was 30.5 ±3.3 (range 21–35) years. All the patients underwent resection of abdominal wall mass and investigation of the pelvic cavity for detecting pelvic endometriosis by laparoscopy. The pelvic endometriosis was scored and the stage was determined. Results 28 (93.3%) patients were found to have concomitant pelvic endometriosis. The mean score of pelvic endometriosis was 9.3 ± 6.6 (range 3–33). Of the patients, 10 (33.3%) suffered from stage I endometriosis, 16 (53.3%) from stage II, and 2 (6.7%) from stage III. Only 2 (6.7%) patients did not have concomitant pelvic endometriosis. The abdominal wall mass was successfully excised in all the cases. The histopathology diagnosis was confirmed in all the cases. Conclusions The association rate between abdominal wall and pelvic endometriosis is higher than that previously reported, up to 90%. Thus, routine investigation of the pelvic cavity is recommended in all the patients with abdominal wall endometriosis.
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Healy EG, McCluggage WG. Abdominal wall endometriosis associated with ventriculoperitoneal and lumboperitoneal shunts: a report of 2 cases of an extremely rare phenomenon. Int J Surg Pathol 2011; 20:301-4. [PMID: 21997593 DOI: 10.1177/1066896911424900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endometriosis is a common condition in women of reproductive age and has a known propensity to involve abdominal wall scars. The authors report 2 cases of endometriosis presenting as mass lesions involving the abdominal wall at the site of insertion of ventriculoperitoneal and lumboperitoneal shunts. In both cases, there was clinical evidence of shunt compromise. Endometriosis involving the site of shunt insertion is an extremely rare phenomenon with, as far as the authors are aware, only a single previously reported case. However, it should be considered in the differential diagnosis when a mass develops at a shunt site in a woman of reproductive age.
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Affiliation(s)
- Estelle G Healy
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland
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Nissotakis C, Zouros E, Revelos K, Sakorafas GH. Abdominal wall endometrioma: a case report and review of the literature. AORN J 2010; 91:730-42; quiz 743-5. [PMID: 20510946 DOI: 10.1016/j.aorn.2010.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 01/06/2010] [Accepted: 01/15/2010] [Indexed: 11/30/2022]
Abstract
Endometriosis is the presence of ectopic endometrial tissue that can respond to ovarian hormonal stimulation. Although it is uncommon, extrapelvic endometriosis can form a discrete mass known as an abdominal wall endometrioma. Endometriomas are thought to be caused by transfer of endometrial cells into a surgical wound, most often after a cesarean delivery. Endometriomas are diagnosed via ultrasound, computed tomography, magnetic resonance imaging, and ultrasound-guided fine needle aspiration. Treatment options can be medical, but surgical excision is the treatment of choice. Perioperative nursing care includes patient teaching, taking steps to prevent surgical site infection and inadvertent hypothermia, ensuring availability of supplies (eg, the graft for abdominal wall repair if needed), and postoperative pain management.
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Iqbal M, Thumbe V, Dhange R, Chan SY, Bhalerao S. Perianal Endometriosis Mimicking Recurrent Perianal Abscess. Case Rep Gastroenterol 2009; 3:414-417. [PMID: 21103264 PMCID: PMC2988940 DOI: 10.1159/000250787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Endometriosis of the perianal region is an extremely rare condition usually seen in episiotomy scars and can involve the septum separating vagina and anal canal. The clinician is unlikely to suspect it if there is no scar in the perineum and patient the does not give a history of episiotomy. Moreover it is difficult to suspect when the patient does not report cyclical pain and therefore it is likely to be treated as perianal sepsis. We report the rare case of a 35-year-old woman who presented with recurrent painful nodule of endometriosis of the perianal area without previous episiotomy.
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Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases. Am J Surg 2008; 196:207-12. [PMID: 18513698 DOI: 10.1016/j.amjsurg.2007.07.035] [Citation(s) in RCA: 202] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 07/10/2007] [Accepted: 07/10/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Abdominal wall endometriosis (AWE) is defined as endometrial tissue superficial to the peritoneum. AWE often is misdiagnosed and referred to surgeons for treatment. We performed a systematic review of published cohorts to quantify demographics, symptoms, and outcomes of patients having AWE. METHODS An English language PubMed search from January 1951 to August of 2006 was conducted using several search terms for endometrioma. CONCLUSIONS Twenty-nine articles describing 455 patients were identified and met inclusion criteria. The pooled mean age was 31.4 years. Ninety-six percent presented with a mass, 87% presented with pain, and 57% presented with cyclic symptoms. AWE was associated with a caesarian scar or hysterectomy in 57% and 11% of cases, respectively. The interval from index surgery to presentation was 3.6 years. Recurrence after resection was 4.3%. The most common presentation of AWE is the development of a painful mass after uterine surgery. Surgical treatment appears to result in a cure more than 95% of the time.
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Abdominal wall endometriosis: an overlooked but possibly preventable complication. Taiwan J Obstet Gynecol 2008; 47:42-8. [PMID: 18400581 DOI: 10.1016/s1028-4559(08)60053-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To find ways of preventing abdominal wall endometriosis through a retrospective case review. MATERIALS AND METHODS A retrospective study of 22 patients presenting with 26 postoperative abdominal wall masses. All masses were pathologically proved to be scar endometriosis between September 1994 and September 2006. The age, parity, symptoms and duration, previous surgeries, interval between previous surgery and current operation, initial diagnosis, and the 26 sites and size of endometrioma were recorded and analyzed. RESULTS About 60% of the patients were in the fourth decade of life. All 22 cases, except one with mid-trimester hysterotomy, had previous cesarean section (CS). Three cases had vertical midline incision for CS, and the other 19 had Pfannenstiel incision, 18 of which were for CS and one for hysterotomy. Of the 22 cases, only three had multiple endometriomas, i.e. one case had three foci and the other two cases had two foci each. Twenty-three endometriomas were found in the Pfannenstiel incision group; 19 out of the 23 foci (82%) were located in either corner of the Pfannenstiel incision wounds (with right side predominance in 13 out of 19). Three endometriomas were noted in vertical midline incisions and two were in the upper corner. Three endometrioma excisions were done during repeated CS. CONCLUSION Abdominal wall endometriosis may be caused by iatrogenic inoculation of the endometrium into the surgical wound. It is strongly recommended that, at the conclusion of the surgical procedure, the abdominal wound be cleaned thoroughly, particularly at both corner sites (especially the operators side). If an abdominal wall endometriosis is encountered after CS but the patient plans to have future pregnancy and the symptoms are mild, excision of the endometrioma may be deferred until the next indicated CS.
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