Papavramidis Th S, Sapalidis K, Michalopoulos N, Karayanopoulou G, Raptou G, Tzioufa V, Kesisoglou I, Papavramidis S T
3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Acta Chir Belg. 2009 Nov-Dec;109(6):778-81. doi: 10.1080/00015458.2009.11680536.
Endometriosis is the presence of endometrial glands and stroma outside the uterus. Spontaneous abdominal wall endometriosis (AWE) is any ectopic endometrium found superficial to the peritoneum without the presence of any previous scar. Rarely, endometriosis represents a disease of specific interest to the general surgeon, on account of its extrapelvic localisations. We describe a case with spontaneous AWE presenting as a painful mass with cyclic symptoms. A 28-year-old woman presented to the day-surgery division of our department, suffering from a painful mass in the left lower abdominal quadrant. A mobile mass of 5 x 4 cm was identified. The initial diagnosis was lipoma and excision was planned. During the operation two masses were spotted, very close to one another, and were excised within healthy limits. Pathology revealed endometrial glands surrounded by a disintegrating mantle of endometrial stroma and fibrous scar tissue in which there was a scattering of leucocytes. The woman had no scars. She was discharged from hospital after 2 hours. Two years after the excision she is free of disease and no recurrence has been observed. Spontaneous AWE is rare, accounting for 20% of all AWEs. The triad ; mass, pain and cyclic symptomatology helps in the diagnosis, but unfortunately it is not present in all cases. Spontaneous endometriomas are usually diagnosed by pathology and the treatment of choice is surgical excision.
子宫内膜异位症是指子宫内膜腺体和间质出现在子宫外。自发性腹壁子宫内膜异位症（AWE）是指在腹膜表面发现的任何异位子宫内膜，且不存在任何既往瘢痕。由于其盆腔外定位，子宫内膜异位症很少成为普通外科医生特别关注的疾病。我们描述了一例以周期性症状的疼痛性肿块为表现的自发性AWE病例。一名28岁女性到我们科室的日间手术部就诊，左下象限有一个疼痛性肿块。发现一个5×4厘米的可移动肿块。初步诊断为脂肪瘤并计划进行切除。手术过程中发现两个肿块，彼此非常靠近，并在健康边界内切除。病理显示子宫内膜腺体被子宫内膜间质和纤维瘢痕组织的崩解性包膜所包围，其中有散在的白细胞。该女性无瘢痕。2小时后出院。切除术后两年，她无疾病，未观察到复发。自发性AWE很罕见，占所有AWE的20%。三联征：肿块、疼痛和周期性症状有助于诊断，但不幸的是并非所有病例都有此表现。自发性子宫内膜瘤通常通过病理诊断，治疗的首选方法是手术切除。
