Fernicola Agostino, Calogero Armando, Peluso Gaia, Santangelo Alfonso, Santangelo Domenico, Crocetto Felice, Califano Gianluigi, Sagnelli Caterina, Cavaliere Annachiara, Sciarra Antonella, Varlese Filippo, Alvigi Antonio, Pignatelli Domenica, D'Alessio Federico Maria, Sommese Martina, Carlomagno Nicola, Santangelo Michele
Department of Advanced Biomedical Sciences, Unit of Emergency Surgery, Federico II University, 80131 Naples, Italy.
Unit of Urology, Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, Vita-Salute San Raffaele University, IRCCS San Raffaele, 20132 Milan, Italy.
J Clin Med. 2025 Aug 1;14(15):5416. doi: 10.3390/jcm14155416.
Abdominal wall endometriosis (AWE) is a rare pathological condition that mostly occurs in the post-cesarean section. This study aimed to describe the surgical approach employed in treating 31 patients at our center over the past decade and compare the outcomes with those reported in scientific literature. We retrospectively evaluated the data of 31 patients with a cesarean section history who underwent surgery for AWE excision between 1 November 2012, and 31 January 2023, at the University of Naples Federico II, Italy. Subsequently, we reviewed the scientific literature for all AWE-related studies published between 1 January 1995, and 31 July 2024. Most women presented with a palpable abdominal mass (90.3%) at the previous surgical site associated with cyclic abdominal pain (80.6%) concomitant with menstruation. All patients underwent preoperative abdominal ultrasound and magnetic resonance imaging, 71% underwent computed tomography, and 32.2% received ultrasound-guided needle biopsies. Furthermore, 90.3% and 9.7% had previous Pfannenstiel and median vertical surgical incisions, respectively. All patients underwent laparotomic excision and abdominal wall reconstruction, with prosthetic reinforcement used in 73.5% of cases. No recurrent nodules were detected in any patient at the 12-month follow-up. AWE should be suspected in women with a history of cesarean section presenting with palpable, cyclically painful abdominal mass associated with the menstrual cycle. Preoperative ultrasound and magnetic resonance imaging are essential, and surgical excision must ensure clear margins. Abdominal wall reconstruction should include prosthetic reinforcement, except when the defect is minimal (≤1.5 cm). An ultrasound follow-up at 12 months is recommended to confirm the absence of recurrence.
腹壁子宫内膜异位症（AWE）是一种罕见的病理状况，大多发生于剖宫产术后。本研究旨在描述过去十年间我们中心治疗31例患者所采用的手术方法，并将结果与科学文献中报道的结果进行比较。我们回顾性评估了2012年11月1日至2023年1月31日期间在意大利那不勒斯费德里科二世大学因AWE切除而接受手术的31例有剖宫产史患者的数据。随后，我们查阅了1995年1月1日至2024年7月31日期间发表的所有与AWE相关的科学文献。大多数女性在前次手术部位可触及腹部肿块（90.3%），伴有与月经周期相关的周期性腹痛（80.6%）。所有患者术前行腹部超声和磁共振成像检查，71%的患者接受了计算机断层扫描，32.2%的患者接受了超声引导下针吸活检。此外，分别有90.3%和9.7%的患者既往采用了耻骨上横切口和正中垂直手术切口。所有患者均接受了剖腹切除和腹壁重建，73.5%的病例使用了假体加固。在12个月的随访中，未在任何患者中检测到复发性结节。有剖宫产史且出现与月经周期相关的可触及的、周期性疼痛的腹部肿块的女性应怀疑患有AWE。术前超声和磁共振成像至关重要，手术切除必须确保切缘清晰。腹壁重建应包括假体加固，除非缺损极小（≤1.5 cm）。建议在12个月时进行超声随访以确认无复发。
