Siddiqui Zohaib A, Husain Fahd, Siddiqui Zain, Siddiqui Midhat
Student, King's College London School of Medical Education, London, UK.
Foundation Year 2, Darent Valley Hospital, Dartford, UK.
BMJ Case Rep. 2017 Jun 18;2017:bcr-2017-219291. doi: 10.1136/bcr-2017-219291.
Endometriomas are a rare cause of abdominal wall pain. We report a case of a port site endometrioma presenting with an umbilical swelling. The patient underwent a laparoscopy for pelvic endometriosis 6 months previously and presented with a swelling around her umbilical port site scar associated with cyclical pain during menses. Ultrasound scan reported a well-defined lesion in the umbilicus and MRI scanning excluded other pathology. As she was symptomatic, she underwent an exploration of the scar and excision of the endometrioma with resolution of her symptoms. Precautions should be taken to reduce the risk of endometrial seeding during laparoscopic surgery. All tissues should be removed in an appropriate retrieval bag and the pneumoperitoneum should be deflated completely before removing ports to reduce the chimney effect of tissue being forced through the port site. The diagnosis should be considered in all women of reproductive age presenting with a painful port site scar.
腹壁子宫内膜异位症是腹壁疼痛的罕见原因。我们报告一例表现为脐部肿胀的穿刺孔部位子宫内膜异位症病例。该患者6个月前因盆腔子宫内膜异位症接受了腹腔镜检查，现脐部穿刺孔部位瘢痕周围出现肿胀，并伴有月经期间的周期性疼痛。超声检查报告脐部有一个边界清晰的病变，磁共振成像扫描排除了其他病变。由于她有症状，故对瘢痕进行了探查，并切除了子宫内膜异位症病灶，症状得以缓解。腹腔镜手术期间应采取预防措施以降低子宫内膜种植的风险。所有组织均应放入合适的回收袋中取出，在移除穿刺孔之前应完全排出气腹，以减少组织通过穿刺孔部位强行挤出的烟囱效应。对于所有出现穿刺孔部位疼痛性瘢痕的育龄女性均应考虑该诊断。
