Ozel Leyla, Sagiroglu Julide, Unal Aysun, Unal Ethem, Gunes Pembegul, Baskent Erdem, Aka Nurettin, Titiz M Izzet, Tufekci E Can
Department of General Surgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey.
J Obstet Gynaecol Res. 2012 Mar;38(3):526-30. doi: 10.1111/j.1447-0756.2011.01739.x. Epub 2012 Feb 16.
The abdominal wall is an uncommon site of extrapelvic endometriosis. It usually develops in a previous surgical scar and should be considered in the differential diagnosis of any abdominal swelling. Classical symptoms of endometriosis may resemble abdominal wall lesions such as an incisional hernia, hematoma, granuloma, abscess or various soft tissue tumors; therefore, a definitive preoperative diagnosis is not always easy to determine in every case. The aim of this article is to review the clinical findings, imaging results and histopathology of those of our patients who have had cesarean scar endometriosis.
Patients diagnosed with abdominal wall endometriosis in their surgical scars from February 2008 to March 2010 were documented. The age, parity, symptoms, previous surgeries, initial diagnosis, diagnostic modalities, definitive operation, postoperative complications, histopathological evaluations and recurrences were recorded and analyzed.
There were 18 patients with a mean age of 34.5 ± 9.6 years. All (100%) had a gradually growing nodular abdominal mass in or adjacent to their cesarean incision scars. This was often associated with pain (83.3%), either noncyclical (26.6%) or cyclical (73.3%) in nature. Ultrasonography (100%), computerized tomography with intravenous contrast (22.2%) and/or magnetic resonance imaging (66.6%) were performed on the patients. All patients underwent surgery and their masses were completely excised. The mean diameter of the removed masses was 3.9 ± 1.4 cm. The final pathological diagnosis for each case was abdominal wall endometriosis. Biannual follow-up examinations for two years revealed that each patient had a complete and uneventful recovery without recurrence.
Abdominal wall endometriosis should be considered in the differential diagnosis of masses located at cesarean section incision scars, which should be excised for definitive diagnosis and treatment.
腹壁是盆腔外子宫内膜异位症的少见部位。它通常在既往手术瘢痕处发生，在任何腹部肿物的鉴别诊断中均应予以考虑。子宫内膜异位症的典型症状可能类似于腹壁病变，如切口疝、血肿、肉芽肿、脓肿或各种软组织肿瘤；因此，并非每个病例都能轻易做出明确的术前诊断。本文旨在回顾我们收治的剖宫产瘢痕子宫内膜异位症患者的临床发现、影像学结果及组织病理学情况。
记录2008年2月至2010年3月期间诊断为手术瘢痕处腹壁子宫内膜异位症的患者情况。记录并分析患者的年龄、产次、症状、既往手术史、初步诊断、诊断方法、确定性手术、术后并发症、组织病理学评估及复发情况。
共18例患者，平均年龄34.5±9.6岁。所有患者（100%）在剖宫产切口瘢痕处或其附近有逐渐增大的结节状腹部肿物。这常伴有疼痛（83.3%），疼痛性质可为非周期性（26.6%）或周期性（73.3%）。对患者进行了超声检查（100%）、静脉造影计算机断层扫描（22.2%）和/或磁共振成像（66.6%）。所有患者均接受了手术，肿物被完整切除。切除肿物的平均直径为3.9±1.4 cm。每例患者的最终病理诊断均为腹壁子宫内膜异位症。两年的每半年一次的随访检查显示，每位患者均完全康复且无复发。
剖宫产切口瘢痕处肿物的鉴别诊断中应考虑腹壁子宫内膜异位症，应将其切除以明确诊断和治疗。
