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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: 25] [Impact Index Per Article: 6.3] [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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Ramdani A, Rais K, Rockson O, Serji B, El Harroudi T. Parietal Mass: Two Case Reports of Rare Cesarean Scar Endometriosis. Cureus 2020; 12:e6918. [PMID: 32190473 PMCID: PMC7061853 DOI: 10.7759/cureus.6918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Scar endometriosis is an uncommon type of extra-pelvic endometriosis. However, it should be suspected in any woman of childbearing age complaining of a cyclic, painful nodule in a scar from a previous obstetric or gynecologic procedure, after excluding other differential diagnoses. The treatment of choice is surgical resection. We report two cases of scar endometriosis that appeared in two young ladies after cesarean sections, discovered by a parietal mass near the cesarean scars.
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Affiliation(s)
- Abdelbassir Ramdani
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Kaoutar Rais
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Obed Rockson
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Badr Serji
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Tijani El Harroudi
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
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3
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Cho YK, Kocol D, Harkins G, Valentine L, Benton A. An Approach to Abdominal-Wall Endometriosis: A Retrospective Case Series. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2018.0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Yonghee Kristina Cho
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Dustin Kocol
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Gerald Harkins
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Lindsey Valentine
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Andrea Benton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
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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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Yarmish G, Sala E, Goldman DA, Lakhman Y, Soslow RA, Hricak H, Gardner GJ, Vargas HA. Abdominal wall endometriosis: differentiation from other masses using CT features. Abdom Radiol (NY) 2017; 42:1517-1523. [PMID: 28004137 DOI: 10.1007/s00261-016-0998-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the utility of morphologic and quantitative CT features in differentiating abdominal wall endometriosis (AWE) from other masses of the abdominal wall. METHODS Retrospective IRB-approved study of 105 consecutive women from two institutions who underwent CT and biopsy/resection of abdominal wall masses. CTs were independently reviewed by two radiologists blinded to final histopathologic diagnoses. Associations between CT features and pathology were tested using Fisher's Exact Test. Sensitivity, specificity, positive, and negative predictive values were calculated. P values were adjusted for multiple variable testing. RESULTS 24.8% (26/105) of patients had histologically proven abdominal wall endometriosis. The other most common diagnoses included adenocarcinoma NOS (21%; 22/105), desmoid (14.3%; 15/105), and leiomyosarcoma (8.6%; 9/105). CT features significantly associated with endometriosis for both readers were location below the umbilicus (P = 0.0188), homogeneous density (P = 0.0188), and presence of linear infiltration irradiating peripherally from a central soft tissue nodule (i.e., "gorgon" sign) (P < 0.0001). The highest combined sensitivity (0.69, 95% CI: 0.48-0.86) and specificity (0.97, 95% CI: 0.91-1.00) for both readers occurred for patients having all three of these features present. Border type (P = 0.0199) was only significant for R2, peritoneal extension (P = 0.0188) was only significantly for R1, and the remainder of features were insignificant (P = 0.06-60). There was overlap in Hounsfield units on non-contrast CT (N = 26) between AWE (median: 45HU, range: 39-54) and other abdominal wall masses (median: 38.5HU, range: 15-58). CONCLUSION CT features are helpful in differentiating AWE from other abdominal wall soft tissue masses. Such differentiation may assist decisions regarding possible biopsy and treatment planning.
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Affiliation(s)
- Gail Yarmish
- Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York, NY, 10305, USA.
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Debra A Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ginger J Gardner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - H Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Scar endometriosis: A series of 3 cases. Med J Armed Forces India 2017; 72:S185-S188. [PMID: 28050109 DOI: 10.1016/j.mjafi.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 07/10/2016] [Indexed: 12/27/2022] Open
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Ecker AM, Donnellan NM, Shepherd JP, Lee TTM. Abdominal wall endometriosis: 12 years of experience at a large academic institution. Am J Obstet Gynecol 2014; 211:363.e1-5. [PMID: 24732005 DOI: 10.1016/j.ajog.2014.04.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/21/2014] [Accepted: 04/09/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of the study was to review patient characteristics and intraoperative findings for excised cases of abdominal wall endometriosis (AWE). STUDY DESIGN A 12 year medical record search was performed for cases of excised AWE, and the diagnosis was confirmed on pathological specimen. Descriptive data were collected and analyzed. RESULTS Of 65 patients included, the primary clinical presentation was abdominal pain and/or a mass/lump (73.8% and 63.1%, respectively). Most patients had a history of cesarean section (81.5%) but 6 patients (9.2%) had no prior surgery. Time from the initial surgery to presentation ranged from 1 to 32 years (median, 7.0 years), and time from the most recent relevant surgery ranged from 1 to 32 years (median, 4.0 years). Five patients (7.7%) required mesh for fascial closure following the resection of the AWE. We were unable to demonstrate a correlation between the increasing numbers of open abdominal surgeries and the time to presentation or depth of involvement. Age, body mass index, and parity also were not predictive of depth of involvement. There were increased rates of umbilical lesions (75% vs 5.6%, P < .001) in nulliparous compared with multiparous women as well as in women without a history of cesarean section (66.7% vs 1.9%, P < .001). CONCLUSION In women with a mass or pain at a prior incision, the differential diagnosis should include AWE. Although we were unable to demonstrate specific characteristics predictive for AWE, a large portion of our population had a prior cesarean section, suggesting a correlation.
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Affiliation(s)
- Amanda M Ecker
- Department of Obstetrics and Gynecology, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Nicole M Donnellan
- Department of Obstetrics and Gynecology, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Jonathan P Shepherd
- Department of Obstetrics and Gynecology, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Ted T M Lee
- Department of Obstetrics and Gynecology, Magee-Womens Hospital of UPMC, Pittsburgh, PA
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Karaman H, Bulut F, Özaşlamacı A. Endometriosis externa within the rectus abdominis muscle. ULUSAL CERRAHI DERGISI 2014; 30:165-8. [PMID: 25931919 DOI: 10.5152/ucd.2014.2035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/04/2013] [Indexed: 12/19/2022]
Abstract
The presence of endometrial glands and stroma outside the uterine cavity is called "endometriosis". Recklinghausen first defined this entity in 1896, and Sampson first named it in detail in 1921. Endometriosis is most often seen in the pelvis. Although extrapelvic endometriosis is rare, it can be seen in almost every organ. Endometriosis localized in the rectus abdominis muscle is very rare. A patient who had two previous cesarean sections presented with a 23 mm heterogeneous hypoechoic mass within the rectus abdominis muscle, approximately 1 cm superior to the Pfannenstiel incision that was diagnosed as endometriosis externa by fine-needle biopsy and excisional biopsy. Herein, we report this patient along with the literature.
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Affiliation(s)
- Hatice Karaman
- Clinic of Pathology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Feridun Bulut
- Clinic of General Surgery, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Aysel Özaşlamacı
- Clinic of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey
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Abstract
AIM: To evaluate endometrioma located at cesarean scatrix.
METHODS: Medical data of 6 patients who presented to our institution with abdominal wall endometrioma were evaluated retrospectively and reviewed literature in this case series. The diagnostic approaches and treatment is discussed.
RESULTS: All patients had a painful mass located at abdominal scars with history of cesarean section. The ages ranged from 31 to 34 and Doppler ultrasonography (US) detected hypoechoic mass with a mean diameter of 30 mm. Initial diagnosis was endometrioma in 4 and incisional hernia in 2 of 6 patients. Treatment was achieved with surgical excision in 5 patients, and one is followed by hormone suppression therapy with gonadotropin.
CONCLUSION: Malignant or benign tumors of abdominal wall and incisional hernias should be kept in mind for diagnosis of endometrioma. Imaging methods like doppler US, computed tomography and magnetic resonance imaging should be used for differential diagnosis. Definitive diagnosis can only be made histopathologically. The treatment should be complete surgical excision and take care against intraoperative auto-inoculation of endometrial tissue in order to prevent recurrences.
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11
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Stein L, Elsayes KM, Wagner-Bartak N. Subcutaneous abdominal wall masses: radiological reasoning. AJR Am J Roentgenol 2012; 198:W146-W151. [PMID: 22268204 DOI: 10.2214/ajr.10.7238] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
OBJECTIVE A 36-year-old woman presented to her primary care physician with right lower abdominal pain. Her physician subsequently requested a CT to rule out appendicitis. Contrast-enhanced CT was performed and revealed no evidence of appendicitis but showed two subcutaneous ovoid soft-tissue masses anterior to the rectus sheath in the upper pelvis. Pelvic MRI confirmed the two masses, which showed mild enhancement. The objective of this article is to discuss a diagnostic approach to subcutaneous soft-tissue masses in the abdominal wall. Diagnosis was endometriosis of the abdominal wall. CONCLUSION Integrating salient imaging findings with clinical history is crucial when approaching the diagnosis of subcutaneous soft-tissue masses. The diagnosis of endometriosis should be entertained when soft-tissue masses are seen in the distribution of a cesarean section scar in a woman of reproductive age. Pain, particularly with a cyclic pattern, is highly suggestive of endometriosis. If endometriosis is suspected on CT or ultrasound, MRI can be performed for further evaluation. Definitive diagnosis is made with biopsy. Because subcutaneous nodules are so amenable percutaneous biopsy, imaging features, although of interest, are somewhat ancillary to the diagnostic workup.
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Affiliation(s)
- Lauren Stein
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
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12
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Song JY, Borncamp E, Mehaffey P, Rotman C. Large abdominal wall endometrioma following laparoscopic hysterectomy. JSLS 2011; 15:261-3. [PMID: 21902990 PMCID: PMC3148886 DOI: 10.4293/108680811x13071180407078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although extrapelvic endometriosis is rare, it should be considered in the diagnosis of the female patient with an abdominal mass and pain who has had a previous surgical procedure. Background: Endometriosis is a common condition in women that affects up to 45% of patients in the reproductive age group by causing pelvic pain. It is characterized by the presence of endometrial tissue outside the uterine cavity and is rarely found subcutaneously or in abdominal incisions, causing it to be overlooked in patients with abdominal pain. Methods: A 45-year-old woman presented with lower abdominal pain 2 years following a laparoscopic supracervical hysterectomy. She was found to have incidental cholelithiasis and a large abdominal mass suggestive of a significant ventral hernia on CT scan. Results: Due to the peculiar presentation, surgical intervention took place that revealed a large 9cm×7.6cm×6.2cm abdominal wall endometrioma. Conclusion: Although extrapelvic endometriosis is rare, it should be entertained in the differential diagnosis for the female patient who presents with an abdominal mass and pain and has a previous surgical history.
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Affiliation(s)
- Jonathan Y Song
- TLC Medical Group, SC, St. Charles, Illinois, Delnor Hospital, Geneva, Illinois, USA
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13
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Ultrasound-guided wired localisation for resection of impalpable anterior abdominal wall scar endometriomas. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10397-011-0678-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tse SY, Chiu TW, Burd A. Scar endometriosis: A case report and review of the literature. SURGICAL PRACTICE 2011. [DOI: 10.1111/j.1744-1633.2010.00519.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nominato NS, Prates LFVS, Lauar I, Morais J, Maia L, Geber S. Caesarean section greatly increases risk of scar endometriosis. Eur J Obstet Gynecol Reprod Biol 2010; 152:83-5. [PMID: 20510495 DOI: 10.1016/j.ejogrb.2010.05.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 04/27/2010] [Accepted: 05/03/2010] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate the incidence of scar endometriosis after different surgical procedures. STUDY DESIGN A retrospective study of 72 patients diagnosed with scar endometriosis between 1978 and 2003 was performed. Patient age, site of endometriosis, previous operations, time-gap between last surgery and onset of symptoms, nodule characteristics, and recurrence were evaluated. RESULTS Age ranged from 16 to 48 years. Location varied according to the previous surgery: 46 caesarean section, one hysterectomy, one in abdominal surgery, 19 episiotomy, one was a relapse and two pelvic floor procedures, two women with no previous surgery. The incidence of scar endometriosis after caesarean section was significantly higher than after episiotomy (0.2 and 0.06%, respectively: p<0.00001) with a relative risk of 3.3. Pain was the most frequent symptom. The mean time between surgery and onset of symptoms was 3.7 years. CONCLUSION Our findings confirm that scar endometriosis is a rare condition and indicate, probably for the first time, that caesarean section greatly increases the risk of developing scar endometriosis.
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Affiliation(s)
- Nilo Sérgio Nominato
- Postgraduate Medical School of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Randriamarolahy A, Perrin H, Cucchi JM, Fuerxer F, Brunner P, Bruneton JN. Endometriosis following cesarean section: ultrasonography and magnetic resonance imaging. Clin Imaging 2010; 34:113-5. [DOI: 10.1016/j.clinimag.2009.08.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 06/26/2009] [Indexed: 11/24/2022]
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