Nirula R, Greaney G C
Department of Surgery, Santa Barbara Cottage Hospital, CA 93105, USA.
J Am Coll Surg. 2000 Apr;190(4):404-7. doi: 10.1016/s1072-7515(99)00286-0.
Incisional endometriosis is a described dinical entity in the gynecologic literature, but it is not well recognized among general surgeons; only 32 cases have been reported in the general surgery literature. The preoperative diagnosis is often mistaken for a suture granuloma, lipoma, abscess, cyst, or incisional hernia.
We performed a retrospective review of 10 cases of incisional endometriosis at our institution to determine which, if any, clinical factors would suggest the diagnosis preoperatively. All general surgery patients who had the diagnosis of endometriosis in their pathology specimens from January 1990 to December 1998 were reviewed.
All 10 patients had previous cesarean sections through either a Pfannenstiel (n = 8) or a lower midline (n = 2) incision. Ages ranged from 27 to 41 years (mean 33.4 years). The most common presenting symptom was a slow-growing, painful lump in the lateral aspect of the Pfannenstiel incision. Two of the patients had a change in symptoms with their menstrual cycle. The duration of symptoms ranged from 2 months to 3 years. All patients underwent surgical excision. The size of the excised endometriomas ranged from 1.5 cm to 4.8 cm (mean 3.1 cm).
Incisional endometriosis may be more common than previously recognized. In all cases it was found to occur in women with a history of cesarean section. Most patients presented with a painful, slow-growing lump at the lateral edge of their incision. Cyclic changes in pain and size of the mass with menses was elicited in only two of these patients, but this may be from a lack of awareness and questioning on the part of the physician. If the diagnosis is made preoperatively, additional diagnostic studies may be avoided. An awareness of this disease process on the part of general surgeons is necessary to guide preoperative evaluation and therapy appropriately.
切口子宫内膜异位症是妇科文献中描述的一种临床病症，但普通外科医生对此认识不足；普通外科文献中仅报道过32例。术前诊断常被误诊为缝线肉芽肿、脂肪瘤、脓肿、囊肿或切口疝。
我们对本机构10例切口子宫内膜异位症病例进行了回顾性研究，以确定哪些临床因素（若有）可在术前提示诊断。对1990年1月至1998年12月间病理标本诊断为子宫内膜异位症的所有普通外科患者进行了回顾。
所有10例患者既往均行剖宫产，其中经Pfannenstiel切口（n = 8）或下腹部正中切口（n = 2）。年龄范围为27至41岁（平均33.4岁）。最常见的症状是Pfannenstiel切口外侧出现缓慢生长的疼痛性肿块。2例患者症状随月经周期改变。症状持续时间为2个月至3年。所有患者均接受了手术切除。切除的子宫内膜瘤大小为1.5 cm至4.8 cm（平均3.1 cm）。
切口子宫内膜异位症可能比之前认为的更常见。所有病例均见于有剖宫产史的女性。大多数患者表现为切口边缘疼痛性、缓慢生长的肿块。仅2例患者肿块的疼痛和大小随月经周期出现变化，但这可能是由于医生缺乏认识和询问不足所致。如果术前做出诊断，可避免进行额外的诊断性检查。普通外科医生了解这一疾病过程对于正确指导术前评估和治疗很有必要。
