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Wu Y, Dai Y, Zhang J, Li X, Shi J, Gu Z, Zhang J, Leng J. The clinical features and long-term surgical outcomes of different types of abdominal wall endometriosis. Arch Gynecol Obstet 2023; 307:163-168. [PMID: 35482067 DOI: 10.1007/s00404-022-06579-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 04/12/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To classify abdominal wall endometriosis (AWE) according to the invasive levels of tissue mass, and to compare the differences in clinical characteristics between different types of AWE. METHODS In this study, we retrospectively analyzed the clinical data of 367 patients who had undergone resection of abdominal-wall endometriotic lesions at the Peking Union Medical College Hospital from January 2008 to December 2018, and we divided the patients into three types according to their deepest level of lesion invasion. Type I designated invasion of skin and subcutaneous tissue; type II, of fascia and rectus abdominis; and type III, of peritoneum. We classified, compared, and analyzed the general conditions, clinical manifestations, auxiliary examinations, surgical conditions, postoperative conditions, and recurrence status of patients. RESULTS Of the 367 patients, type I patients accounted for 13.62%, type II patients for 56.68%, and type III for 29.7%. With respect to group comparisons, we observed that as the location of the mass deepened, the rate of concurrent pelvic endometriosis increased (P = 0.007), recurrent AWE was augmented (P = 0.02), the size of the mass increased (P < 0.001), the rate of multiple lesions became elevated (P < 0.001), the rate of mesh implantation increased (P < 0.001), the length of postoperative hospital stay (P < 0.001) was lengthened, the number of postoperative fever cases (P = 0.006) increased, and the risk of drainage placement (P < 0.001) was enhanced. The 5-year cumulative recurrence rate was 3.3%, and there was no significant difference in the recurrence rate among various types of AWE. CONCLUSION Type III AWE carries more severe clinical manifestations, larger lesion size, longer operative time, greater intraoperative surgical difficulty, higher necessity of mesh implantation, and longer postoperative recovery process. Complete resection of AWE lesion is the main therapeutically approach and shows relatively low long-term recurrency rate.
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Affiliation(s)
- Yushi Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Yi Dai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Junji Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Xiaoyan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Jinghua Shi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Zhiyue Gu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Jing Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Jinhua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
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Chen LY, Hsu SD. Scar Endometriosis Presenting as a Painful Abdominal Mass. Gynecol Minim Invasive Ther 2020; 9:98-100. [PMID: 32676289 PMCID: PMC7354748 DOI: 10.4103/gmit.gmit_74_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/23/2019] [Accepted: 02/04/2020] [Indexed: 11/09/2022] Open
Abstract
Abdominal wall scar endometriosis occurs in 1%–2% of women following a cesarean section delivery. We report a case of a 36-year-old woman with scar endometriosis, presenting with an acute, painful abdominal wall mass. She underwent a cesarean section 8 years before presentation. She was admitted to the emergency room for physical examination of the abdomen, which revealed a palpable mass. Abdominal computed tomography (CT) revealed an ill-defined soft-tissue lesion over the left rectus abdominis muscle (abdominal scar). Surgical removal of the abdominal wall mass was performed with adequate clearance margins with a preoperative diagnosis of postcesarean scar endometriosis. Postcesarean scar endometriosis is a rare cause of an abdominal mass; however, when this condition presents acutely, it can be difficult to diagnose. In this case, careful analysis of the patient's history, CT images, and histopathological results together confirmed the diagnosis. Surgical excision was performed under general anesthesia while maintaining adequate clearance margins.
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Affiliation(s)
- Li-Yung Chen
- Department of Surgery, Gangshan Branch, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.,Department of Surgery, Song Shan Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sheng-Der Hsu
- Division of General Surgery, Department of Surgery, Tri. Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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3
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Carsote M, Terzea DC, Valea A, Gheorghisan-Galateanu AA. Abdominal wall endometriosis (a narrative review). Int J Med Sci 2020; 17:536-542. [PMID: 32174784 PMCID: PMC7053307 DOI: 10.7150/ijms.38679] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/27/2020] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Mara Carsote
- Department of Endocrinology, "Carol Davila" University of Medicine and Pharmacy, 050474, Bucharest, Romania; "C.I. Parhon" National Institute of Endocrinology, 011863, Bucharest, Romania
| | - Dana Cristiana Terzea
- Department of Pathology, "C.I. Parhon" National Institute of Endocrinology, 011863, Bucharest, Romania
| | - Ana Valea
- Department of Endocrinology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania
| | - Ancuta-Augustina Gheorghisan-Galateanu
- Department of Cellular and Molecular Biology and Histology, "Carol Davila" University of Medicine and Pharmacy, 050474, Bucharest, Romania; "C.I. Parhon" National Institute of Endocrinology, 011863, Bucharest, Romania
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Abdominal Wall Endometrioma: A Diagnostic Enigma-A Case Report and Review of the Literature. Case Rep Obstet Gynecol 2019. [PMID: 31032131 DOI: 10.1155/2019/6831545.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment. Introduction Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an incidence of less than 2% following gynaecologic operations. Case Report A case of abdominal wall endometrioma diagnosed clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of this condition. Discussion The etiopathogenesis, presentation, investigations, and management are discussed briefly. Conclusion Clinical evaluation confirmed by supportive imaging is diagnostic. Wide local excision is the mainstay of treatment.
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Vagholkar K, Vagholkar S. Abdominal Wall Endometrioma: A Diagnostic Enigma-A Case Report and Review of the Literature. Case Rep Obstet Gynecol 2019; 2019:6831545. [PMID: 31032131 PMCID: PMC6457300 DOI: 10.1155/2019/6831545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/17/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment. INTRODUCTION Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an incidence of less than 2% following gynaecologic operations. CASE REPORT A case of abdominal wall endometrioma diagnosed clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of this condition. DISCUSSION The etiopathogenesis, presentation, investigations, and management are discussed briefly. CONCLUSION Clinical evaluation confirmed by supportive imaging is diagnostic. Wide local excision is the mainstay of treatment.
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Affiliation(s)
- Ketan Vagholkar
- Department of Surgery, D. Y. Patil University School of Medicine, Navi Mumbai 400706, MS, India
| | - Suvarna Vagholkar
- Department of Surgery, D. Y. Patil University School of Medicine, Navi Mumbai 400706, MS, India
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Tatli F, Gozeneli O, Uyanikoglu H, Uzunkoy A, Yalcın HC, Ozgonul A, Bardakci O, Incebiyik A, Guldur ME. The clinical characteristics and surgical approach of scar endometriosis: A case series of 14 women. Bosn J Basic Med Sci 2018; 18:275-278. [PMID: 29285999 PMCID: PMC6087557 DOI: 10.17305/bjbms.2018.2659] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/23/2017] [Accepted: 12/23/2017] [Indexed: 01/21/2023] Open
Abstract
Scar endometriosis, also referred to as abdominal wall endometriosis (AWE), is a rare form of endometriosis that usually develops in the scar after obstetric or gynecological surgeries, including cesarean section (CS). Recently, the occurrence of scar endometriosis has been increasing together with the increase of CS incidence. Scar endometriosis can be clinically misdiagnosed as hernia, lipoma, or hematoma. Here we retrospectively analyzed the clinical aspects of scar endometriosis 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, scar endometriosis was diagnosed in 12/14 patients (85.7%), while 2 patients (14.3%) were diagnosed with inguinal hernia. The treatment was surgical excision in all patients; in addition, mesh repair surgery was performed in 1 patient with recurrent scar endometriosis. Postoperatively, endometriosis was confirmed by histology in all patients. The average size of endometriomas was 24.71 ± 6.67 mm (range: 11-35). No woman had concurrent pelvic endometriosis. In the follow-up period (mean: 9 months) the recurrence of endometriosis was not observed. Scar endometriosis should be considered in all women of reproductive age presenting with cyclic pain and swelling in their abdominal incision sites.
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Affiliation(s)
- Faik Tatli
- Department of General Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Orhan Gozeneli
- Department of General Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Hacer Uyanikoglu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Ali Uzunkoy
- Department of General Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Huseyin Cahit Yalcın
- Department of General Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Abdullah Ozgonul
- Department of General Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Osman Bardakci
- Department of General Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Adnan Incebiyik
- Department of Obstetrics and Gynecology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Muhammet Emin Guldur
- Department of Pathology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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Cesarean Scar Endometriosis: An Uncommon Surgical Complication on the Rise? Case Report and Literature Review. Case Rep Obstet Gynecol 2017; 2017:8062924. [PMID: 28326210 PMCID: PMC5343249 DOI: 10.1155/2017/8062924] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/08/2017] [Indexed: 11/17/2022] Open
Abstract
Endometriosis is defined by the presence and growth of ectopic functional endometrial tissue outside the uterus. Scar endometriosis has been described following obstetrical and gynecological surgery. It is a rare condition, though probably on the rise, due to the considerable increase of cesarean sections performed worldwide. Its physiopathology is complex; its symptomatology is rich and diverse but thorough clinical examination along with ultrasound imaging and potentially pretherapeutic cytologic evaluation are usually efficient in diagnosing the condition. Treatment is mostly surgical. We report the case of a cesarean section scar endometriosis, managed at a tertiary level center and emphasize the diagnosis and treatment options.
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Sumathy S, Mangalakanthi J, Purushothaman K, Sharma D, Remadevi C, Sreedhar S. Symptomatology and Surgical Perspective of Scar Endometriosis: A Case Series of 16 Women. J Obstet Gynaecol India 2016; 67:218-223. [PMID: 28546671 DOI: 10.1007/s13224-016-0945-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/10/2016] [Indexed: 11/27/2022] Open
Abstract
AIM The prevalence of scar endometriosis is increasing with the increasing caesarean deliveries and laparoscopic procedures done for pelvic endometriosis. To analyse the symptomatology and surgical perspective of scar endometriosis. MATERIALS AND METHODS Retrospective review of 16 women who underwent surgery for scar endometriosis in the period of 4 years in Amrita institute of medical sciences. RESULTS Mean age of the patients is 35.19 years. Mean interval from the index surgery to the presentation is 4.56 years. Mean size of the swelling is 2.84 cm. In 68.8% of the patients, caesarean section was the inciting surgery. 18.7% had port site endometriosis. Cyclical pain and swelling at the scar site was present in 93.8% of the women. 18.9% had concurrent pelvic endometriosis. All women had involvement of the subcutaneous tissue followed by 11 women with the involvement of rectus sheath. There was no recurrence of the lesion in the operated patients in the mean follow-up period of 11.91 months. CONCLUSION In all women presenting with cyclical scar site pain and swelling, scar endometriosis should be considered. It commonly follows caesarean section and laparoscopic surgeries done for endometriosis. Wide local excision with or without reconstruction is the method of choice for this condition. Role of tumescent solution during surgery and postoperative medical management to reduce recurrence needs further prospective studies.
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Affiliation(s)
- Sudha Sumathy
- Department of Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Janu Mangalakanthi
- Department of Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Kishore Purushothaman
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Deepti Sharma
- Department of Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Chithra Remadevi
- Department of Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - Sarala Sreedhar
- Department of Obstetrics and Gynaecology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
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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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Sproedt J, Schulz A, Jandali AR. [In Process Citation]. Chirurg 2015; 86:1151-2. [PMID: 26016709 DOI: 10.1007/s00104-015-0014-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J Sproedt
- Klinik für Hand- und Plastische Chirurgie, Kantonsspital Winterthur, 8401, Winterthur, Schweiz.
| | - A Schulz
- Klinik für Hand- und Plastische Chirurgie, Kantonsspital Winterthur, 8401, Winterthur, Schweiz
| | - A R Jandali
- Klinik für Hand- und Plastische Chirurgie, Kantonsspital Winterthur, 8401, Winterthur, Schweiz
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