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Rahman NA, Shope T. Cyclically bleeding trocar-site endometrioma without known history of endometriosis: case report and literature review. J Surg Case Rep 2022; 2022:rjac498. [PMID: 36389442 PMCID: PMC9659428 DOI: 10.1093/jscr/rjac498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 01/25/2023] Open
Abstract
Endometriosis occurrence at a laparoscopic trocar-site incision is extremely rare with only 30 previous cases published. We present a 43-year-old female with surgical history of two cesarean sections and a laparoscopic Roux-en-Y gastric bypass who presented with history of cyclical bleeding from an umbilical mass coinciding with her menstrual cycle. Ultrasound demonstrated a complex solid and cystic lesion measuring 2.5 x 1.4 x 1.4 cm. This umbilical mass was surgically resected and gross examination perioperatively demonstrated dark-colored cystic implants consistent with endometrioma. Pathology confirmed the suspected diagnosis of endometriosis. There are several noteworthy characteristics in this unique case of laparoscopic trocar-site endometrioma. Umbilical bleeding is an unusual presenting symptom that has not been previously reported. This endometrioma occurred at the umbilical laparoscopic site rather than her Pfannenstiel incision. Laparoscopic Roux-en-Y gastric bypass has not been previously associated with trocar-site endometrioma. Of note, this patient had no known history of endometriosis.
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Affiliation(s)
- Naveed A Rahman
- Correspondence address. Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA. Tel: +1 443-760-5402; E-mail:
| | - Timothy Shope
- SUNY Upstate Medical University, Department of Surgery, Syracuse, NY 13210, USA
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2
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Paramythiotis D, Karlafti E, Tsomidis I, Iraklis G, Malliou P, Karakatsanis A, Antonios M. Abdominal wall endometriosis: a case report. Pan Afr Med J 2022; 41:193. [PMID: 35685105 PMCID: PMC9146603 DOI: 10.11604/pamj.2022.41.193.33536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/07/2022] [Indexed: 11/11/2022] Open
Abstract
Abdominal wall endometriosis is the development of endometrial tissue in the anterior abdomen usually due to an operation in which the uterus is manipulated. We herein delineate the presentation, clinical investigation, and surgical treatment of an abdominal wall endometriosis case. A 42-year-old female presented with acute abdominal pain in the lower quadrants in the margins of an old cesarean scar. Two masses in the abdominal wall highly suspected of consisting of endometrial tissue were found during the investigation of the patient. These ones were removed in surgery and endometrial tissue secondary to previous cesarean section was confirmed after histological analysis. Consequently, although rare, if a painful mass in a surgical scar, such as a Pfannenstiel incision, is found in women of reproductive age with a history of obstetric surgery, the differential diagnosis shall include endometriosis. There is a portion of cases in which endometriosis recurs within five years following conservative surgery.
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Affiliation(s)
- Daniel Paramythiotis
- First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece
| | - Eleni Karlafti
- Emergency Department, AHEPA University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece
| | - Ioannis Tsomidis
- First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece
| | - George Iraklis
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece
| | - Petra Malliou
- First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece
| | - Anestis Karakatsanis
- First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece
| | - Michalopoulos Antonios
- First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece
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3
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Endometriosis arising in a cesarean section scar: A case report. Int J Surg Case Rep 2022; 92:106862. [PMID: 35231741 PMCID: PMC8885982 DOI: 10.1016/j.ijscr.2022.106862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction and importance Scar endometriosis is an uncommon variant of extra pelvic endometriosis, which develops at the scar site of previous abdominopelvic surgery and is seen in women during their reproductive period. Case presentation We report a 38-year-old female who presented with a nine-months history of a painful ulcerative mass that developed on a cesarean section scar. The mass was removed by a wide excision and confirmed by histology to be endometriosis. Clinical discussion Wide surgical resection of ectopic endometriosis is the treatment of choice. It is usually curative and ensures the confirmation of the diagnosis. Conclusion Cesarean section scar endometriosis can undergo malignant transformation. This case highlights the need for early detection and treatment. Cesarean section scar endometriosis is an uncommon variant of extra pelvic endometriosis Wide surgical resection of ectopic endometriosis is the treatment of choice. Scar endometriosis can undergo malignant transformation; therefore, early detection and treatment is of a dire need
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4
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Hirata T, Koga K, Osuga Y. Extra-pelvic endometriosis: A review. Reprod Med Biol 2020; 19:323-333. [PMID: 33071634 PMCID: PMC7542014 DOI: 10.1002/rmb2.12340] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background Extra‐pelvic endometriosis is a rare type of endometriosis, which occurs in a distant site from gynecological organs. The diagnosis of extra‐pelvic endometriosis can be extremely challenging and may result in a delay in diagnosis. The main objective of this review was to characterize abdominal wall endometriosis (AWE) and thoracic endometriosis (TE). Methods The authors performed a literature search to provide an overview of AWE and TE, which are the major types of extra‐pelvic endometriosis. Main findings Abdominal wall endometriosis includes scar endometriosis secondary to the surgical wound and spontaneous AWE, most of which occur in the umbilicus or groin. Surgical treatment appeared to be effective for AWE. Case reports indicated that the diagnosis and treatment of catamenial pneumothorax or endometriosis‐related pneumothorax (CP/ERP) are challenging, and a combination of surgery and postoperative hormonal therapy is essential. Further, catamenial hemoptysis (CH) can be adequately managed by hormonal treatment, unlike CP/ERP. Conclusion Evidence‐based approaches to diagnosis and treatment of extra‐pelvic endometriosis remain immature given the low prevalence and limited quality of research available in the literature. To gain a better understanding of extra‐pelvic endometriosis, it would be advisable to develop a registry involving a multidisciplinary collaboration with gynecologists, general surgeons, and thoracic surgeons.
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Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and Gynecology Doai Kinen Hospital Sumida-ku Japan.,Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
| | - Kaori Koga
- Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
| | - Yutaka Osuga
- Faculty of Medicine Department of Obstetrics and Gynecology University of Tokyo Tokyo Japan
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Ao X, Xiong W, Tan SQ. Laparoscopic umbilical trocar port site endometriosis: A case report. World J Clin Cases 2020; 8:1532-1537. [PMID: 32368547 PMCID: PMC7190959 DOI: 10.12998/wjcc.v8.i8.1532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/09/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abdominal wall endometriosis can occur secondary to gynecological and obstetric pelvic laparotomy; however, this is a rare clinical event. There are few cases of endometriosis involving the incision site of a laparoscopic surgery, especially for those of the endometrial nodule at the umbilical trocar port site where the camera is placed.
CASE SUMMARY We describe the case of a 37-year-old woman who presented with a 2-year history of a tough swelling below the umbilicus, which presented periodical pain during menstruation. The patient had undergone laparoscopic ovarian cystectomy 4 years prior, and we theorized that the umbilical nodule was a complication of that laparoscopic surgery. Histological analysis confirmed the diagnosis of abdominal umbilical scar endometriosis secondary to previous laparoscopic surgery. Surgical removal of the nodule followed by three cycles of leuprorelin was curative.
CONCLUSION Abdominal mass and pain in women of childbearing age with a previous history of pelvic surgery should support consideration of endometriosis at the surgical site.
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Affiliation(s)
- Xue Ao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Wei Xiong
- Department of Obstetrics and Gynecology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Shi-Qiao Tan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
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6
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Abdominal wall mass suspected of endometriosis: clinical and pathologic features. Obstet Gynecol Sci 2020; 63:357-362. [PMID: 32489981 PMCID: PMC7231946 DOI: 10.5468/ogs.2020.63.3.357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/16/2019] [Accepted: 11/06/2019] [Indexed: 12/18/2022] Open
Abstract
Objective To evaluate the clinical and pathological characteristics of lower anterior abdominal wall masses suspicious for endometriosis. Methods A retrospective review of 38 patients who underwent surgery for a lower anterior abdominal wall mass suspicious for endometriosis was performed. Those with skin and intraperitoneal masses, lipomas, hernias, and metastatic malignant masses were excluded. Patient age, body mass index, delivery history, dysmenorrhea, and mass size and location were analyzed. Results Thirty-seven (97.3%) patients had a relevant surgical history, including 35 (92.1%) with a history of cesarean section (C/S). Among the three patients with no history of C/S, 1 underwent total abdominal and another total laparoscopic hysterectomy, and 1 had no previous surgical history. The mean (±standard deviation) size of the abdominal masses was 3.2±1.2 cm. One patient developed a recurrent mass after excision of abdominal wall endometriosis. Trocar site endometrioma was found in one patient following total laparoscopic hysterectomy. According to the final pathology reports, endometriosis was found in 35 (92.1%) of patients. The remaining 3 patients (7.9%) had malignancy: adenocarcinoma, squamous cell carcinoma, and extra-gastrointestinal stromal tumor. Before surgery, only 3 patients (7.9%) underwent fine-needle aspiration biopsy of the masses, which were all postoperatively confirmed to be pathologically benign. Conclusion Although most abdominal wall masses in the present sample were endometriosis occurring at the scar site from a previous operation, 7.9% of patients ultimately exhibited malignancy. Therefore, all patients with suspected anterior wall endometriosis should undergo preoperative biopsy to identify the few that will have an alternative diagnosis.
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Tsuruga T, Hirata T, Akiyama I, Matsumoto Y, Oda K, Fujii T, Osuga Y. Mixed endometrioid and clear cell carcinoma arising from laparoscopic trocar site endometriosis. J Obstet Gynaecol Res 2019; 45:1613-1618. [PMID: 31183953 DOI: 10.1111/jog.14014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/15/2019] [Indexed: 12/19/2022]
Abstract
Laparoscopic port site endometriosis is less common in abdominal wall endometriosis, and malignant transformation of abdominal wall endometriosis is rare. We reported a case of mixed endometrioid and clear cell carcinoma arising from port site endometriosis. The patient was a 49-year-old woman with a history of laparoscopic excision of ovarian endometrioma. Physical examination revealed a subcutaneous solid tumor around the laparoscopic surgical scar. Imaging showed a suspicious malignancy. She underwent radical marginal resection of the abdominal wall tumor, flap reconstruction of the abdominal wall, hysterectomy, bilateral salpingo-oophorectomy and omental biopsy. Histological examination revealed mixed endometrioid and clear cell carcinoma. Computed tomography scan showed no evidence of recurrence after six cycles of chemotherapy. This is the first case of malignant transformation from laparoscopic trocar site endometriosis.
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Affiliation(s)
- Tetsushi Tsuruga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuya Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, Doai Kinen Hospital, Tokyo, Japan
| | - Ikumi Akiyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.,Department of Obstetrics and Gynecology, Doai Kinen Hospital, Tokyo, Japan
| | - Yoko Matsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Katsutoshi Oda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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8
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Amini M, Moghbeli M. Appendectomy Scar Endometriosis: A Case Report. Middle East J Dig Dis 2018; 10:114-116. [PMID: 30013761 PMCID: PMC6040921 DOI: 10.15171/mejdd.2018.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 03/10/2018] [Indexed: 11/30/2022] Open
Abstract
Scar endometriosis is one of the rare cases of surgery, which specifically occurs in gynecological
surgeries. It is important to do a correct diagnosis in such rare cases to have an efficient
treatment. The disease is commonly observed in child-bearing women with clinical manifestations
such as acute abdomen or chronic and cyclic pelvic pain. Herein we reported a case of
appendectomy scar endometriosis.
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Affiliation(s)
- Mohadeseh Amini
- Assistant Professor, Department of surgery, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Meysam Moghbeli
- Assistant Professor, Clinical Research Development Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
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9
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Merlot B, Ploteau S, Abergel A, Rubob C, Hocke C, Canis M, Fritel X, Roman H, Collinet P. [Extragenital endometriosis: Parietal, thoracic, diaphragmatic and nervous lesions. CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29530553 DOI: 10.1016/j.gofs.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
According to some studies, extragenital endometriosis represents 5% of the localisations. Its prevalence seems to be underestimated. The extra pelvic localisation can make the diagnosis more difficult. Nevertheless, the recurrent and catamenial symptomatology can evoke this pathology. Surgery seems to be the unique efficient treatment for parietal lesions. Pain linked to nervous lesions (peripheric and sacral roots) seems to be underestimated and difficult to diagnose because of various localisations. Neurolysis seems to have encouraging results. Diaphragmatic lesions are often discovered either incidentally during laparoscopy, or by pulmonary symptomatology as recurrent catamenial pneumothorax or cyclic thoracic pain. Surgical treatment seems as well to be efficient.
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Affiliation(s)
- B Merlot
- Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France.
| | - S Ploteau
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital mère-enfant, CHU de Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France
| | - A Abergel
- Médecine de la reproduction, clinique Jean-Villar, avenue Maryse-Bastié, 33520 Bruges, France
| | - C Rubob
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, CHRU de Lille, 59000 Lille, France
| | - C Hocke
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor-d'Aquitaine, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - M Canis
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, Inserm CIC 1402, université de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - H Roman
- Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - P Collinet
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, CHRU de Lille, 59000 Lille, France
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10
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Adamyan LV, Starodubtseva N, Borisova A, Stepanian AA, Chagovets V, Salimova D, Wang Z, Kononikhin A, Popov I, Bugrova A, Chingin K, Kozachenko A, Chen H, Frankevich V. Direct Mass Spectrometry Differentiation of Ectopic and Eutopic Endometrium in Patients with Endometriosis. J Minim Invasive Gynecol 2017; 25:426-433. [PMID: 28888701 DOI: 10.1016/j.jmig.2017.08.658] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 08/23/2017] [Accepted: 08/28/2017] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE To introduce a method for the rapid assessment of endometriotic tissues using direct mass spectrometry (MS)-based lipidomics. DESIGN A prospective observational cohort study (Canadian Task Force classification II2). SETTING Department of Operative Gynecology of the Research Centre for Obstetrics, Gynecology and Perinatology. PATIENTS Fifty patients with ovarian cysts and peritoneal endometriosis who underwent laparoscopic surgery between 2014 and 2016. INTERVENTION Differences in mass spectrometric profiles of ectopic endometria (endometriosis) and eutopic endometria were analyzed for each patient in combination with morphohistologic evaluation. The lipidomic approach was applied using a direct high-resolution MS method. MEASUREMENTS AND MAIN RESULTS Of 148 metabolites, 15 showed significant differences between endometriotic tissue and a healthy endometrium of the same patient, considered as a control in this study. The main lipids prevalent in endometriotic tissues were phosphoethanolamine (PE O-20:0), sphingomyelin (SM 34:1), diglycerides (DG 44:9), phosphatidylcholines (PC 32:1, PC O-36:3, PC 38:7, PC 38:6, PC 40:8, PC 40:7, PC 40:6, PC 40:9, and PC O-42:1), and triglycerides (TG 41:2, TG 49:4, and TG 52:3). Using partial least squares discriminant analysis models, MS showed that the lipidomic profile of endometriotic tissue (peritoneal endometriosis and ovarian endometriomas) was clearly separated from the eutopic endometrium, indicating tissue-type differentiation. CONCLUSION Our results suggest that direct MS may play an important role for endometriotic tissue identification. Such an approach has potential usefulness for real-time tissue determination and differentiation during surgical treatment. Lipids of 3 important classes, sphingolipids, phospholipids, and the fatty acids (di- and triglycerides), were identified. Validation is required to determine whether these lipids can be used to discriminate between patients with endometriosis and those with other gynecologic diseases.
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Affiliation(s)
- Leila V Adamyan
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Natalia Starodubtseva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russia; Moscow Institute of Physics and Technology, Moscow, Russia
| | - Anna Borisova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Assia A Stepanian
- Academia of Women's Health and Endoscopic Surgery, Atlanta, Georgia.
| | - Vitaliy Chagovets
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Dinara Salimova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Zhihao Wang
- Jiangxi Key Laboratory for Mass Spectrometry and Instrumentation, East China University of Technology, Nanchang, China
| | - Alexey Kononikhin
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russia; Moscow Institute of Physics and Technology, Moscow, Russia
| | - Igor Popov
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russia; Moscow Institute of Physics and Technology, Moscow, Russia
| | - Anna Bugrova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Konstantin Chingin
- Jiangxi Key Laboratory for Mass Spectrometry and Instrumentation, East China University of Technology, Nanchang, China
| | - Andrey Kozachenko
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Huanwen Chen
- Jiangxi Key Laboratory for Mass Spectrometry and Instrumentation, East China University of Technology, Nanchang, China
| | - Vladimir Frankevich
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russia
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11
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Siddiqui ZA, Husain F, Siddiqui Z, Siddiqui M. Port site endometrioma: a rare cause of abdominal wall pain following laparoscopic surgery. BMJ Case Rep 2017. [PMID: 28630240 DOI: 10.1136/bcr-2017-219291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Endometriomas are a rare cause of abdominal wall pain. We report a case of a port site endometrioma presenting with an umbilical swelling. The patient underwent a laparoscopy for pelvic endometriosis 6 months previously and presented with a swelling around her umbilical port site scar associated with cyclical pain during menses. Ultrasound scan reported a well-defined lesion in the umbilicus and MRI scanning excluded other pathology. As she was symptomatic, she underwent an exploration of the scar and excision of the endometrioma with resolution of her symptoms. Precautions should be taken to reduce the risk of endometrial seeding during laparoscopic surgery. All tissues should be removed in an appropriate retrieval bag and the pneumoperitoneum should be deflated completely before removing ports to reduce the chimney effect of tissue being forced through the port site. The diagnosis should be considered in all women of reproductive age presenting with a painful port site scar.
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Affiliation(s)
- Zohaib A Siddiqui
- Student, King's College London School of Medical Education, London, UK
| | - Fahd Husain
- Foundation Year 2, Darent Valley Hospital, Dartford, UK
| | - Zain Siddiqui
- Foundation Year 1, Lewisham and Greenwich NHS Trust, London, UK
| | - Midhat Siddiqui
- Upper GI Consultant Surgeon, Queen Elizabeth Hospital, London, UK
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12
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Diagnosis and Management of Abdominal Wall Endometriosis: A Systematic Review and Clinical Recommendations. Obstet Gynecol Surv 2017; 72:116-122. [PMID: 28218772 DOI: 10.1097/ogx.0000000000000399] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Abdominal wall endometriosis (AWE) is a rare but easily treated cause of pain in women, especially those who have undergone cesarean deliveries. Objective This article reviews the diagnosis and management of AWE, a condition that generally develops after surgery but may arise spontaneously. We present a systematic review of the existing literature on AWE, as well as our clinical recommendations for medical and surgical management. Evidence Acquisition We searched PubMed and other databases using the search criteria "abdominal wall endometriosis," "abdominal wall endometriomas," and "abdominal wall mass." The references of those articles were then reviewed, and additional publications were evaluated. Results Many case reports and case series have been published describing AWE. The overall quality of evidence is poor due to the lack of prospective studies and heterogeneous descriptions of AWE lesions and treatment options. Based on the available literature, it appears that AWE may arise spontaneously but is generally associated with prior pelvic surgery. Abdominal wall endometriosis can be diagnosed with a careful history and physical examination. Imaging including ultrasound and magnetic resonance imaging can assist with localization of the lesions, and aid in surgical excision and management. Lesions that have been removed in their entirety are unlikely to reoccur. Conclusions and Relevance Although limited, the body of literature describing management of AWE suggests that it can be successfully treated in most patients with careful surgical planning.
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13
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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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14
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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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15
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El Fahssi M, Lomdo M, Bounaim A, Ali AA, Sair K. [Parietal-scar endometriosis after cesarean section: a rare entity]. Pan Afr Med J 2016; 24:79. [PMID: 27642418 PMCID: PMC5012785 DOI: 10.11604/pamj.2016.24.79.8680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 01/13/2016] [Indexed: 11/11/2022] Open
Abstract
Wall endometriosis is a rare clinical entity whose pathophysiology remains unclear. It occurs most frequently after gynecologic or obstetric surgery. We report the case of a patient with cyclic pain at the caesarean section scar. Clinical examination showed a 5 cm mass in the right iliac fossa. Tomodensitometry revealed a tissue density mass (45mm on the major axis). Hence, the decision to perform a wide excision of the lesion. Anatomo-pathological examination confirmed the diagnosis of parietal endometriosis. Postoperative sequelae were simple with a follow-up period of 20 months with no recurrence of the mass or of the pain. Our study highlights the characteristics of this disease to allow the health practitioner to understand the importance of diagnosis, of early treatment of this disease as well as of the possibility to prevent it during each gynecologic or obstetric surgery.
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Affiliation(s)
- Mohammed El Fahssi
- Service de Chirurgie Viscérale I de l'Hôpital Militaire Mohammed V, Rabat, Maroc
| | - Massama Lomdo
- Service de Chirurgie Viscérale I de l'Hôpital Militaire Mohammed V, Rabat, Maroc
| | - Ahmed Bounaim
- Service de Chirurgie Viscérale I de l'Hôpital Militaire Mohammed V, Rabat, Maroc
| | - Abdelmounaim Ait Ali
- Service de Chirurgie Viscérale I de l'Hôpital Militaire Mohammed V, Rabat, Maroc
| | - Khalid Sair
- Service de Chirurgie Viscérale I de l'Hôpital Militaire Mohammed V, Rabat, Maroc
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16
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Abdominal Wall Endometrioma after Laparoscopic Operation of Uterine Endometriosis. Case Rep Surg 2016; 2016:5843179. [PMID: 27340586 PMCID: PMC4906174 DOI: 10.1155/2016/5843179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 04/06/2016] [Indexed: 11/17/2022] Open
Abstract
Endometriosis is presence of functional endometrium outside of uterine cavum. As a pluripotent tissue, endometrium has the possibility of implanting itself almost everywhere; even implantation in abdominal wall was described, but it is not common site. This case report presents implantation of functional endometrium in abdominal wall, inside scar tissue, and after insertion of a laparoscopic trocar port. Final diagnosis was confirmed by pathohistological examination.
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17
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Cozzolino M, Magnolfi S, Corioni S, Moncini D, Mattei A. Abdominal Wall Endometriosis on the Right Port Site After Laparoscopy: Case Report and Literature Review. Ochsner J 2015; 15:251-255. [PMID: 26412997 PMCID: PMC4569157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Endometriosis can be intrapelvic or, rarely, extrapelvic. Endometriosis involving the rectus abdominis muscle on the trocar port site is a rare event; until now, only 16 cases have been reported in the literature. The majority of cases were associated with previous abdominal surgery such as diagnostic laparoscopy, cyst excision, appendectomy, myomectomy, or cholecystectomy. We review all the reported cases of this unusual form of extrapelvic endometriosis. CASE REPORT We report a new case of abdominal wall endometriosis at the trocar port site in the rectus abdominis muscle in a woman who had undergone 2 laparoscopies for endometriosis in the 3 years before coming to our attention. The diagnosis was made by sonography. We performed a surgical resection of the lesion with a free macroscopic margin of 5-10 mm. CONCLUSION Endometriosis should be considered in the differential diagnosis of any abdominal swelling. In our experience, surgery is the treatment of choice.
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Affiliation(s)
- Mauro Cozzolino
- Department of Biomedical, Experimental, and Clinical Sciences–Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Stefania Magnolfi
- Department of Biomedical, Experimental, and Clinical Sciences–Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Serena Corioni
- Department of Biomedical, Experimental, and Clinical Sciences–Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Daniela Moncini
- Department of Biomedicine, Histology, and Molecular Diagnostics, Careggi University Hospital, Florence, Italy
| | - Alberto Mattei
- Department of Biomedical, Experimental, and Clinical Sciences–Division of Obstetrics and Gynecology, University of Florence, Florence, Italy
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18
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Dhawan AK, Singh S, Tyagi M, Arora V. Scar with recurrent serosanguinous discharge. Clin Exp Dermatol 2014; 40:213-5. [PMID: 25251614 DOI: 10.1111/ced.12462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2014] [Indexed: 10/24/2022]
Affiliation(s)
- A K Dhawan
- Department of Dermatology, UCMS and GTB Hospital, Delhi, India
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19
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A Surgeon's Perspective of Abdominal Wall Endometriosis at a Caesarean Section Incision: Nine Cases in a Single Institution. Surg Res Pract 2014; 2014:765372. [PMID: 25379559 PMCID: PMC4207379 DOI: 10.1155/2014/765372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/11/2014] [Indexed: 12/18/2022] Open
Abstract
Abdominal wall endometriosis in a Caesarean section scar (AEC) is an infrequent type of extrapelvic endometriosis which rarely transforms into a malignant lesion. A painful mass located in the scar of a Caesarean section is a typical sign of AEC. This condition is diagnosed preoperatively using imaging modalities such as computed tomography and ultrasonography, as well as fine-needle aspiration. Although AEC has typical signs, general surgeons often misdiagnose it due to its rarity. Herein, we report our experience of AEC in a single institution.
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20
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Yi C, Li L, Wang X, Liu X. Recurrence of uterine tissue residues after laparoscopic hysterectomy or myomectomy. Pak J Med Sci 2014; 30:1134-6. [PMID: 25225541 PMCID: PMC4163247 DOI: 10.12669/pjms.305.4509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 11/04/2013] [Accepted: 06/25/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report a new complication after laparoscopic surgery i.e recurrence of endometrium and leiomyoma fragments from uterine tissue residues after laparoscopic hysterectomy or laparoscopic myomectomy. Methods : This study was carried out on three patients with the recurrence of endometrium or leiomyoma fragments from tissue residues after laparoscopic hysterectomy or laparoscopic myomectomy in the First Affiliated Hospital, Yangtze University, China. We also explored the possible reasons and corresponding preventative strategies. RESULTS Small residues of endometrium and leiomyoma fragments could implant into normal tissue anywhere in the peritoneal cavity after laparoscopic myomectomy or laparoscopic hysterectomy. CONCLUSION These cases emphasize the importance of removing every single fragment to prevent the recurrence of endometrium and leiomyoma from tissue residues.
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Affiliation(s)
- Cunjian Yi
- Cunjian Yi, MD, PhD , Department of Obstetrics and Gynecology, First Affiliated Hospital, Yangtze University, Jingzhou, Hubei Province 434000, P.R. China
| | - Li Li
- Li Li, MD, Department of Obstetrics and Gynecology, First Affiliated Hospital, Yangtze University, Jingzhou, Hubei Province 434000, P.R. China
| | - Xiaowen Wang
- Xiaowen Wang, MD , Department of Obstetrics and Gynecology, First Affiliated Hospital, Yangtze University, Jingzhou, Hubei Province 434000, P.R. China
| | - Xiangqiong Liu
- Xiangqiong Liu , MD, Department of Obstetrics and Gynecology, First Affiliated Hospital, Yangtze University, Jingzhou, Hubei Province 434000, P.R. China
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