Christina Natalia Maria, Candrawinata Valeska Siulinda, Lie Hendry, Godam Kezia Imanuella
Department of Surgery, Faculty of Medicine, Pelita Harapan University, Siloam General Hospital, Tangerang, Indonesia.
Department of Surgery, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia.
Int J Surg Case Rep. 2023 Aug;109:108495. doi: 10.1016/j.ijscr.2023.108495. Epub 2023 Jul 14.
Endometriosis is one of the most frequent gynecologic disorders, clinically confirmed or suspected in one of nine women by the age of 44 years. Its location of occurrence can be classified into intra and extra pelvic. Abdominal wall endometriosis (AWE) is one of its rare location, with frequency of 0.04 to 5.5 %. Furthermore there are only a few cases of AWE in Indonesia that have been reported.
Here we present two Indonesian patients at a General Hospital in Tangerang, Indonesia. The first patient, 26 years old, complained of an umbilical mass 2 years after caesarean section. The second patient, 36 years old, complained of an umbilical mass since 8 months, with no history of prior surgery. Both patients had pre-operative ultrasonography (US) and underwent wide local excision. Histopathology examination with presence of endometrial glandular components and endometrial-like stroma confirmed the diagnosis of AWE.
AWE is defined as any endometrial tissue found superficial to the peritoneum, locating most commonly at umbilical, inguinal area, and anterior abdominal wall. Pre-operative diagnostic tools include abdominal ultrasonography (US) or abdominopelvic computed tomography (CT) scan. Since treatment with medications is usually not effective, surgical treatment is recommended, along with confirmation by histopathological examination.
Diagnosis of AWE should be suspected in all women with symptoms of an abdominal mass and cyclic pain, especially if the patient had history of surgery at the abdominal region. AWE is quite rare, but its symptoms can affect quality of life. Hence, a multi-disciplinary approach is necessary, with the strongly recommended treatment of wide local excision to prevent recurrence and malignant transformation.
子宫内膜异位症是最常见的妇科疾病之一，在44岁的女性中，每九人就有一人临床确诊或疑似患有该病。其发生部位可分为盆腔内和盆腔外。腹壁子宫内膜异位症（AWE）是其罕见的发病部位之一，发病率为0.04%至5.5%。此外，印度尼西亚仅有少数AWE病例被报道。
在此，我们介绍印度尼西亚坦格朗一家综合医院的两名患者。第一名患者，26岁，剖宫产术后2年出现脐部肿物。第二名患者，36岁，8个月来一直主诉脐部肿物，无既往手术史。两名患者术前均进行了超声检查（US），并接受了广泛局部切除。组织病理学检查发现子宫内膜腺体成分和子宫内膜样间质，确诊为AWE。
AWE被定义为腹膜表面发现的任何子宫内膜组织，最常见于脐部、腹股沟区和前腹壁。术前诊断工具包括腹部超声检查（US）或腹盆腔计算机断层扫描（CT）。由于药物治疗通常无效，建议进行手术治疗，并通过组织病理学检查进行确诊。
所有有腹部肿物和周期性疼痛症状的女性都应怀疑患有AWE，尤其是有腹部手术史的患者。AWE相当罕见，但其症状会影响生活质量。因此，需要采取多学科方法，强烈建议采用广泛局部切除的治疗方法以防止复发和恶变。
