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Al Shenawi H, Al Shenawi N, Al Mousa NA, Al Abbas LA, Al Zayer NM, Alqhtani MM, Naguib Y. A Typical Presentation of Cesarean Section Scar Endometriosis: A Case Report. Cureus 2023; 15:e49884. [PMID: 38053990 PMCID: PMC10694546 DOI: 10.7759/cureus.49884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 12/07/2023] Open
Abstract
Endometriosis is the presence of ectopic functioning endometrial tissue outside the uterine cavity. Scar endometriosis is a rare condition that typically follows obstetrical and gynecological surgeries. Although the symptoms are non-specific and varying, scar endometriosis classically presents with cyclic pain at the site of incision during menstruation. The diagnosis of scar endometriosis remains challenging and requires a comprehensive approach, including clinical presentation and histological and radiological findings. Here, we present a case of extragonadal endometriosis at the cesarean section scar. The patient presented with cyclical menstrual pain at the surgical incision. Our aim in this case report is to present the approach to diagnosing such a condition with the associated presentation and histological findings.
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Affiliation(s)
| | | | | | | | | | | | - Yahya Naguib
- Physiology, Arabian Gulf University, Manama, BHR
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2
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Durairaj A, Sivamani H, Panneerselvam M. Surgical Scar Endometriosis: An Emerging Enigma. Cureus 2023; 15:e35089. [PMID: 36945281 PMCID: PMC10024799 DOI: 10.7759/cureus.35089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction Surgical scar endometriosis is a subtype of extra-pelvic endometriosis that is characterized by the formation of endometrial tissue near the incision site in patients who have previously undergone surgery. In recent times, with the increasing trend in Caesarean sections, the incidence of surgical scar endometriosis has also emerged. This study aims to describe the clinical characteristics and management of surgical scar endometriosis. Methodology We conducted this cross-sectional, observational study over eight years (2015-2022) in a tertiary care centre in Madurai district, Tamil Nadu, India. We conducted this study after acquiring an ethical certificate from the institutional ethics committee (IEC No. VMCIEC/22/2018). In this study, we sampled all women (n = 32) with a pathological diagnosis of scar endometriosis during the study period from hospital records (universal sampling). We searched the data for both general characteristics and lesion characteristics of the patients. The general characteristics include age, body mass index (BMI), parity, mode of delivery, symptoms, and imaging by ultrasound. We have recorded the lesion characteristics of the patient, including location and size of scar endometriosis, layers involved in scar endometriosis, and surgical technique from surgical notes written in the case sheet. The minimum sample size required for this study was 31 study subjects. We entered the data into Excel (Microsoft, Redmond, WA, USA) and analyzed it in SPSS version 21 (IBM Corp., Armonk, NY, USA). We expressed the quantitative variables in terms of mean and standard deviation and the qualitative variables in terms of frequency and percentage. Results The mean age of the study participants was 34 years (range 23-55 years). In our study, 29 patients (90.6%) were multi-para, and only three (9.4%) were nullipara. Among 29 parous women, the majority (25, or 77.7%) had delivered by Caesarean section, while only four (12.5%) delivered by normal vaginal delivery. The surgical procedures preceding the scar endometriosis were predominantly obstetric procedures (87.4%), out of which 25 patients underwent a Caesarean section and only three underwent an episiotomy. The most common presenting symptom of scar endometriosis in our study was cyclical pain in the scar site (90.4%), followed by swelling (81.25%). In 62.5% of patients, the duration between the presentation of surgical scar endometriosis and surgical intervention was greater than one year. Subcutaneous tissue (90.6%) was the most commonly involved layer in surgical scar endometriosis, followed by the rectus sheath (86.2%). The surgical procedure done for scar endometriosis was wide local excision in 78% of patients, and the remaining 22% of patients had wide local excision with mesh repair. Conclusion Cesarean section is an obvious risk factor for surgical scar endometriosis. Clinicians should have a high index of suspicion for surgical scar endometriosis in women presenting with cyclic pain at the scar site. Ultrasound is accurate in diagnosing scar endometriosis. Surgical management by wide local excision with a clear margin with or without mesh repair is the treatment of choice.
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Affiliation(s)
- Anitha Durairaj
- Obstetrics and Gynaecology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Harini Sivamani
- Obstetrics and Gynaecology, Velammal Medical College Hospital and Research Institute, Madurai, IND
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3
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Mehdi K, Kumar A. Spontaneous cutaneous endometriosis in Mons Pubis: review of literature. Med J Armed Forces India 2023; 79:105-108. [PMID: 36605350 PMCID: PMC9807684 DOI: 10.1016/j.mjafi.2020.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/21/2020] [Indexed: 01/07/2023] Open
Abstract
Cutaneous endometriosis is not a very often seen condition and is broadly classified as primary (spontaneous) and secondary. While perineal endometriosis arising in a previous scar has been reported, spontaneous cutaneous endometriosis in perineum is extremely rare and only three cases occurring in mons pubis have been reported in literature. We report a case of 34-year-old lady presented with a swelling in pubic region and associated dull aching pain of 1-year duration with no history of cyclical variation of symptoms. Investigations finally concluded a diagnosis of endometriosis and a Complete excision with clear margins. Clinicians should be aware that a spontaneous endometriosis in the perineum can occur and can have atypical presentation with no increase in size or pain during menstruation.
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Affiliation(s)
- K.M. Mehdi
- Graded Specialist (Surgery), 5 Air Force Hospital, Jorhat, India
| | - Ameet Kumar
- Senior Advisor (Surgery) & GI Surgeon, 5 Air Force Hospital, Jorhat, India
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4
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Scar Endometriosis: A Rare Cause of Abdominal Pain. Dermatopathology (Basel) 2022; 9:158-163. [PMID: 35645231 PMCID: PMC9149924 DOI: 10.3390/dermatopathology9020020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
Scar endometriosis or incisional endometriosis is the presence of endometrial tissues with glands in the previous incision or scar. Its overall estimated incidence after post-cesarean and post-hysterectomy is 0.03–0.4% and 1.08–2%, respectively. The patient presents with non-specific symptoms such as cyclical abdominal pain at the site of a previous surgical incision and scar and an abdominal lump with a cyclical increment in size, which is tender. The diagnosis is made only after the surgical excision with confirmation by histopathological analysis. We present the case of a 31-year-old female complaining of cyclical abdominal pain and a lump on the right side of a Pfannenstiel incision for five months. She had undergone two Lower Segment Caesarean Sections (LSCSs); the last surgery was eight months prior. Surgical excision was planned with the corresponding clinical features and radiological data. After the surgical excision, the sample was sent for histopathological examination, and scar endometriosis was diagnosed.
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5
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Gülaydın N. The Effect of Diagnosis and Surgical Margin Safety on the Success of Treatment in Endometriomas after Cesarean Section. ISTANBUL MEDICAL JOURNAL 2022. [DOI: 10.4274/imj.galenos.2022.94220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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6
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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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Domínguez Alvarado G, D’vera Camargo D, Leal Bernal J, Reyes Espinel D, Rueda García C, López Gómez L. Recidiva de endometriosis en pared abdominal. Reporte de caso. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2021.100669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Permatasari NUI, Hutabarat FF, Putri HMAR. Scar endometriosis diagnosed as incisional hernia before surgery. BMJ Case Rep 2021; 14:e239923. [PMID: 33947672 PMCID: PMC8098922 DOI: 10.1136/bcr-2020-239923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 11/04/2022] Open
Abstract
Scar endometriosis is a rare condition highly related to history of abdominal surgery. Due to the low incidence, it is often misdiagnosed. A woman presented to the surgery outpatient clinic with a mass near her C-section scar. Physical examination and ultrasound suggested Incisional Hernia while intraoperative finding revealed a mass suggestive of endometriosis which later confirmed by pathology examination. Scar endometriosis is a common subtype of extra-pelvic endometriosis. Iatrogenic transplantation is speculated to be its etiopathogenesis. Preoperatively, it is challenging to differentiate endometriosis from another abdominal masses. The definitive diagnosis is based on laparoscopy or surgery with histological verification. Chronic pain is complex and often involves multiple factors beyond simply a diagnosis of endometriosis, but it is important to think of endometriosis on women patients presenting with a mass and cyclic pain with history of surgery involving a large amount of endometrial cell.
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9
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Taghavi MR, Mollazadeh S, Bagheri Mansoori M, Asadi M. Skin endometriosis between the breasts of a young girl: A case study and literature review. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2019. [DOI: 10.1177/2284026519891577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Endometriosis is defined as the presence of functional endometrial glands and stroma outside the uterine cavity. Skin involvement is a rare presentation of this common complication. The purpose of this study is to introduce a markedly atypical case of the skin endometriosis with periodic pains located between the breasts of the 24-year-old girl. Care report: In this case, the patient with unknown periodic discharges and painful lesion presented in different consulting diagnostics centers for her complaint. After various diagnostic procedures and treatments, she underwent an excision biopsy to evaluate endometriosis. The history of periodic fluid findings of this case aid to indicate endometriosis. This case also emphasizes the significance of suspecting not only the atypical locations of endometriosis but also presentations of endometriosis. Follow-up tests indicated that she was risk-free of endometriosis relapsing status. Conclusion: The atypical endometriosis sites can present with varied ranges of symptoms, especially ones occurred periodically with menses in young females.
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Affiliation(s)
- Mohammad Reza Taghavi
- Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
- Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Samaneh Mollazadeh
- Natural Products and Medicinal Plants Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mohammad Bagheri Mansoori
- Laboratory of Treata Hospital, Tehran, Iran
- Laboratory of Sohrevardi Neurology Specialist Clinic, Tehran, Iran
| | - Mehdi Asadi
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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10
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Marras S, Pluchino N, Petignat P, Wenger JM, Ris F, Buchs NC, Dubuisson J. Abdominal wall endometriosis: An 11-year retrospective observational cohort study. Eur J Obstet Gynecol Reprod Biol X 2019; 4:100096. [PMID: 31650130 PMCID: PMC6804734 DOI: 10.1016/j.eurox.2019.100096] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 08/29/2019] [Accepted: 09/08/2019] [Indexed: 12/29/2022] Open
Abstract
Objective The objective of this study was to review the records of patients with excised abdominal wall endometriosis (AWE) to determine patient characteristics, diagnostic methods, presence of concurrent pelvic endometriosis and type of surgery. Study design Medical records from an 11-year period were searched to identify histologically confirmed AWE cases. Descriptive data were collected and analyzed. Two subgroups were differentiated: isolated AWE and pelvic endometriosis-associated AWE. Results Thirty-five women with AWE were included. The most common symptom was cyclic abdominal or parietal pain (68.6%); 17.1% of the women had no symptoms. Twenty-nine women (82.8%) had a history of gynecological or obstetrical surgery, most commonly cesarean section (CS). The mean interval between prior surgery and appearance of symptoms was 5.3 years. Six women (17.1%) had no prior surgery; all six presented with umbilical nodules, nulliparity and confirmed mild to severe pelvic endometriosis. Among all patients, 34.3% had concurrent pelvic endometriosis, 40% presented with isolated AWE and 25.7% had no pelvic exploration. Women with concurrent pelvic endometriosis had significantly lower parity, smaller nodule size and a higher likelihood of umbilical location than those with isolated AWE (p < 0.05). A history of CS was more commonly found in women with isolated AWE. The overall recurrence rate over the study period was 11.4%, with a mean follow-up period of 5.2 years. Conclusions AWE is an uncommon condition associated with long diagnostic and therapeutic delays. In patients with umbilical AWE and no surgical history, pelvic endometriosis is commonly present and should be highly suspected.
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Affiliation(s)
- Sandra Marras
- Department of Obstetrics and Gynecology, Geneva University Hospitals, 30 Boulevard de la Cluse, Geneva 1211, Switzerland
| | - Nicola Pluchino
- Department of Obstetrics and Gynecology, Geneva University Hospitals, 30 Boulevard de la Cluse, Geneva 1211, Switzerland
| | - Patrick Petignat
- Department of Obstetrics and Gynecology, Geneva University Hospitals, 30 Boulevard de la Cluse, Geneva 1211, Switzerland
| | - Jean-Marie Wenger
- Faculty of Medicine, University of Geneva, 1 Rue Michel Servet, Geneva 1205, Switzerland
| | - Frédéric Ris
- Department of Surgery, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, Geneva 1211, Switzerland
| | - Nicolas C Buchs
- Department of Surgery, Geneva University Hospitals, Rue Gabrielle Perret Gentil 4, Geneva 1211, Switzerland
| | - Jean Dubuisson
- Department of Obstetrics and Gynecology, Geneva University Hospitals, 30 Boulevard de la Cluse, Geneva 1211, Switzerland
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11
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Abdominal Wall Clear Cell Carcinoma: Case Report of a Rare Event with Potential Diagnostic Difficulties. Case Rep Pathol 2019; 2019:1695734. [PMID: 31396428 PMCID: PMC6668542 DOI: 10.1155/2019/1695734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/07/2019] [Indexed: 12/14/2022] Open
Abstract
Clear cell carcinoma (CCC) is a well-known aggressive histological type of carcinoma, predominantly seen in ovary and endometrium. However, CCC arising in abdominal wall is a very rare event. We report a case of a 48-year-old woman with an abdominal wall mass at her cesarean section (c-section) scar, which increased in size and became painful in the last months. Radiology revealed a 7 cm mass in the right inferior rectus muscle sheath, suggestive of endometriosis. An irregular, firm mass was resected, densely adherent to the rectus muscle and pubic bone. Frozen section revealed a multicystic lesion with minimal cytologic atypia, and a benign cystic neoplasm was favored. However, permanent sections showed marked nuclear atypia, hobnail morphology, and areas of infiltrative growth within fibrous stroma. No benign endometrial glands were found, although fibrosis and hemorrhage were present. Napsin-A, racemase, and PAX-8 were positive, consistent with CCC, likely arising within a c-section endometriosis focus. Although CCC usually presents with moderate to marked nuclear atypia, it can be mild and, especially in cases with a predominant cystic pattern, create diagnostic difficulties. An endometriosis-associated malignancy should be considered in the differential with any enlarging nodule or increasing pain within an abdominal wall scar.
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Muacevic A, Adler JR. Catamenial Rectus Abdominis Pain Associated with Scar Endometriosis Status-post Low Transverse Cesarean Section. Cureus 2018; 10:e3778. [PMID: 30854266 PMCID: PMC6395013 DOI: 10.7759/cureus.3778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Endometriosis is the presence of endometrial tissue outside of the uterine cavity. Scar endometriosis (SE), a rare occurrence, results from inadvertent extrapelvic transplantation of endometrial tissue to an incision site, such as from a low transverse cesarean section (LTCS). The reported incidence of abdominal wall scar endometriosis status-post cesarean section is 0.03 - 0.6%. We present a case of rectus abdominis scar endometriosis diagnosed four years following an LTCS. Our case report discusses the history/presentation, imaging findings, histopathology, and pertinent literature concerning abdominal wall scar endometriosis.
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Yıldırım D, Tatar C, Doğan O, Hut A, Dönmez T, Akıncı M, Toptaş M, Bayık RN. Post-cesarean scar endometriosis. Turk J Obstet Gynecol 2018. [PMID: 29662714 DOI: 10.4274/tjod.90922.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective Endometriosis is seen in women during their reproductive period, where stromal tissue and functional endometrial glands of the uterus are observed outside the uterine cavity. In this study, we aimed to identify the clinical characteristics of our patients who underwent surgery with scar endometriosis and to discuss the surgical results in light of the literature. Materials and Methods A total of 24 patients who underwent surgery and diagnosed as having endometriosis as the result of a pathologic examination were retrospectively evaluated. Results The mean age of the patients was 31 years. Thirteen presented to general surgery and 11 presented to gynecology outpatient clinics. The pain was cyclical in 19 patients. There was history of cesarean section in 9 patients, twice in 12, and 3 times in three patients. The mean diameter was 39.1 mm on ultrasound, and 37.5 mm on magnetic resonance imaging. Endometriosis was on the left side of the incisions in 13, whereas it was on the right in 11. The mean weight of the lesions was 61.6 grams. Conclusion The occurrence of endometriosis is supported by the iatrogenic implantation theory. In the event of a mass in the abdominal wall, previous obstetric and gynecologic operations and a history of a painful mass during menstruation periods must be questioned. In the treatment of scar endometriosis, excision is required by obtaining secure margins. If diagnosis can be established preoperatively, unnecessary surgeries can prevented.
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Affiliation(s)
- Doğan Yıldırım
- University of Health Sciences, Haseki Training and Research Hospital, Clinic of General Surgery, İstanbul, Turkey
| | - Cihad Tatar
- University of Health Sciences, Haseki Training and Research Hospital, Clinic of General Surgery, İstanbul, Turkey
| | - Ozan Doğan
- Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Adnan Hut
- University of Health Sciences, Haseki Training and Research Hospital, Clinic of General Surgery, İstanbul, Turkey
| | - Turgut Dönmez
- Lutfiye Nuri Burat State Hospital, Clinic of General Surgery, İstanbul, Turkey
| | - Muzaffer Akıncı
- University of Health Sciences, Haseki Training and Research Hospital, Clinic of General Surgery, İstanbul, Turkey
| | - Mehmet Toptaş
- University of Health Sciences, Haseki Training and Research Hospital, Clinic of Anestehesiology, İstanbul, Turkey
| | - Rahime Nida Bayık
- Bahçeşehir University Faculty of Medicine, Göztepe Medical Park Hospital, Department of Obstetrics and Gynecology, İstanbul, Turkey
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14
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Yıldırım D, Tatar C, Doğan O, Hut A, Dönmez T, Akıncı M, Toptaş M, Bayık RN. Post-cesarean scar endometriosis. Turk J Obstet Gynecol 2018; 15:33-38. [PMID: 29662714 PMCID: PMC5894534 DOI: 10.4274/tjod.90922] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/15/2017] [Indexed: 01/10/2023] Open
Abstract
Objective: Endometriosis is seen in women during their reproductive period, where stromal tissue and functional endometrial glands of the uterus are observed outside the uterine cavity. In this study, we aimed to identify the clinical characteristics of our patients who underwent surgery with scar endometriosis and to discuss the surgical results in light of the literature. Materials and Methods: A total of 24 patients who underwent surgery and diagnosed as having endometriosis as the result of a pathologic examination were retrospectively evaluated. Results: The mean age of the patients was 31 years. Thirteen presented to general surgery and 11 presented to gynecology outpatient clinics. The pain was cyclical in 19 patients. There was history of cesarean section in 9 patients, twice in 12, and 3 times in three patients. The mean diameter was 39.1 mm on ultrasound, and 37.5 mm on magnetic resonance imaging. Endometriosis was on the left side of the incisions in 13, whereas it was on the right in 11. The mean weight of the lesions was 61.6 grams. Conclusion: The occurrence of endometriosis is supported by the iatrogenic implantation theory. In the event of a mass in the abdominal wall, previous obstetric and gynecologic operations and a history of a painful mass during menstruation periods must be questioned. In the treatment of scar endometriosis, excision is required by obtaining secure margins. If diagnosis can be established preoperatively, unnecessary surgeries can prevented.
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Affiliation(s)
- Doğan Yıldırım
- University of Health Sciences, Haseki Training and Research Hospital, Clinic of General Surgery, İstanbul, Turkey
| | - Cihad Tatar
- University of Health Sciences, Haseki Training and Research Hospital, Clinic of General Surgery, İstanbul, Turkey
| | - Ozan Doğan
- Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Adnan Hut
- University of Health Sciences, Haseki Training and Research Hospital, Clinic of General Surgery, İstanbul, Turkey
| | - Turgut Dönmez
- Lutfiye Nuri Burat State Hospital, Clinic of General Surgery, İstanbul, Turkey
| | - Muzaffer Akıncı
- University of Health Sciences, Haseki Training and Research Hospital, Clinic of General Surgery, İstanbul, Turkey
| | - Mehmet Toptaş
- University of Health Sciences, Haseki Training and Research Hospital, Clinic of Anestehesiology, İstanbul, Turkey
| | - Rahime Nida Bayık
- Bahçeşehir University Faculty of Medicine, Göztepe Medical Park Hospital, Department of Obstetrics and Gynecology, İstanbul, Turkey
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15
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Kocher M, Hardie A, Schaefer A, McLaren T, Kovacs M. Cesarean-Section Scar Endometrioma: A Case Report and Review of the Literature. J Radiol Case Rep 2017; 11:16-26. [PMID: 29290906 DOI: 10.3941/jrcr.v11i12.3178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Endometriomas can occur after any surgery where there is endometrial manipulation, and there are a number of reports of endometriomas developing in the abdominal wall at the site of the Pfannenstiel incision following Cesarean-section. Although this is ultimately a histopathologically-confirmed diagnosis, preoperative imaging including ultrasound, computed tomography, and magnetic resonance imaging may be helpful in the diagnosis and assessment. We report a pathology-confirmed case of Cesarean-section endometrioma with a classic, clinical presentation and imaging findings on computed tomography. A comprehensive literature review and discussion of the multi-modality imaging appearance of Cesarean-section endometrioma is also provided.
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Affiliation(s)
- Madison Kocher
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Hardie
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Amanda Schaefer
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas McLaren
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Mark Kovacs
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
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Pas K, Joanna SM, Renata R, Skręt A, Barnaś E. Prospective study concerning 71 cases of caesarean scar endometriosis (CSE). J OBSTET GYNAECOL 2017; 37:775-778. [PMID: 28395567 DOI: 10.1080/01443615.2017.1305333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Katarzyna Pas
- a Clinical Department of Obstetrics and Gynecology , State Hospital , Rzeszów , Poland
| | - Skręt-Magierło Joanna
- a Clinical Department of Obstetrics and Gynecology , State Hospital , Rzeszów , Poland
| | - Raś Renata
- a Clinical Department of Obstetrics and Gynecology , State Hospital , Rzeszów , Poland
| | - Andrzej Skręt
- a Clinical Department of Obstetrics and Gynecology , State Hospital , Rzeszów , Poland
| | - Edyta Barnaś
- b Institute of Obstetrics and Emergency Medicine, University of Rzeszow , Rzeszów , Poland
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17
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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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