Wolf Y, Haddad R, Werbin N, Skornick Y, Kaplan O
Department of General Surgery A, Tel Aviv Sourasky Medical Center, Israel.
Am Surg. 1996 Dec;62(12):1042-4.
Endometriosis is ectopic endometrial tissue that responds to hormonal stimulation and is found in 8 to 15 per cent of all menstruating women. Endometrioma in a surgical scar is rare and appears in 0.1 per cent of women who have undergone cesarean section; 25 per cent of these women have concomitant pelvic endometriosis. Endometrioma in a scar can present as a painful swelling on the scar that worsens during cough and effort, with the patient's complaints resembling those of a postoperative hernia occurring in a scar. It can also mimic other lesions of the abdominal wall, such as hematomas, granulomas, abscesses, and tumors. Four cases of endometriomas in a cesarean section scar are described. Two were diagnosed preoperatively as postoperative ventral hernias, and the other two presented with an abdominal wall mass causing pain and discomfort. All patients underwent surgery, and the error of their preoperative diagnosis was revealed by histology, which confirmed endometrioma. We contend that endometrioma in scarring is a diagnostic pitfall that should be considered in the differential diagnosis of postoperative ventral hernias and various abdominal wall masses.
子宫内膜异位症是指异位的子宫内膜组织，其对激素刺激有反应，在所有有月经的女性中，发病率为8%至15%。手术瘢痕内的子宫内膜瘤罕见，在剖宫产术后女性中的发生率为0.1%；其中25%的女性伴有盆腔子宫内膜异位症。瘢痕内的子宫内膜瘤可表现为瘢痕处疼痛性肿胀，咳嗽和用力时加重，患者的症状类似于瘢痕处发生的术后疝。它也可模仿腹壁的其他病变，如血肿、肉芽肿、脓肿和肿瘤。本文描述了4例剖宫产瘢痕内子宫内膜瘤的病例。其中2例术前被诊断为术后腹疝，另外2例表现为引起疼痛和不适的腹壁肿块。所有患者均接受了手术，组织学检查揭示了术前诊断的错误，确诊为子宫内膜瘤。我们认为，瘢痕内子宫内膜瘤是一个诊断陷阱，在术后腹疝和各种腹壁肿块的鉴别诊断中应予以考虑。
