Scar endometriosis after a laparotomy for uterine perforation as a complication of dilatation and curettage

Kurotsuchi S, Shozo Kurotsuchi, Akira Iwase, Iwase A, Maki Goto, Goto M, Yumi Hariyama, Hariyama Y, Kikkawa F, Fumitaka Kikkawa
Archives of gynecology and obstetrics · 2009 · doi:10.1007/s00404-009-0963-x · PMID:19214544
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A 38-year-old woman developed scar endometriosis following a laparotomy for uterine perforation, with hormonal therapy providing symptomatic relief and lesion reduction.

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This case report describes a 38-year-old woman who developed scar endometriosis three years after undergoing a laparotomy to repair a uterine perforation that occurred during dilatation and curettage. The patient presented with cyclic pain and swelling at the surgical site, and a biopsy confirmed the presence of ectopic endometrial tissue within the abdominal scar. Hormonal therapy using a gonadotropin-releasing hormone agonist was administered as a conservative management strategy, which successfully provided symptomatic relief and reduced the lesion size without requiring further surgery. This paper is centrally about endometriosis — specifically an extremely rare case of scar endometriosis resulting from iatrogenic implantation during a complication of a gynecological procedure.

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Abstract

BACKGROUND: Ectopic endometriosis is an uncommon disease. Abdominal scar endometriosis is especially rare. CASE: A 38-year-old gravid 1, para 1 woman underwent dilatation and curettage due to an intrauterine infection. During the procedure, uterine perforation occurred and an emergency laparotomy was performed to provide hemostasis and suturing. Three years later, she complained of pain and swelling at the lower end of her abdominal scar during menstruation. A biopsy of the abdominal scar demonstrated endometriosis. The patient elected to receive conservative management rather than a surgical procedure. Therefore, hormonal therapy was initiated. The hormonal therapy provided symptomatic relief and reduced the size of the lesion. CONCLUSION: We reported an extremely rare case of scar endometriosis after a laparotomy for a uterine perforation that occurred as a complication of dilatation and curettage. We suggest that hormonal therapy using gonadotropin-releasing hormone agonist might be an alternative to surgical treatment for ectopic endometriosis.
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Abstract

Background Ectopic endometriosis is an uncommon disease. Abdominal scar endometriosis is especially rare. Case A 38-year-old gravid 1, para 1 woman underwent dilatation and curettage due to an intrauterine infection. During the procedure, uterine perforation occurred and an emergency laparotomy was performed to provide hemostasis and suturing. Three years later, she complained of pain and swelling at the lower end of her abdominal scar during menstruation. A biopsy of the abdominal scar demonstrated endometriosis. The patient elected to receive conservative management rather than a surgical procedure. Therefore, hormonal therapy was initiated. The hormonal therapy provided symptomatic relief and reduced the size of the lesion.

Conclusion

We reported an extremely rare case of scar endometriosis after a laparotomy for a uterine perforation that occurred as a complication of dilatation and curettage. We suggest that hormonal therapy using gonadotropin-releasing hormone agonist might be an alternative to surgical treatment for ectopic endometriosis.

References

Minaglia S, Mishell DR Jr, Ballard CA (2007) Incisional endometriomas after Cesarean section: a case series. J Reprod Med 52:630–634 Koger KE, Shatney CH, Hodge K, McClenathan JH (1993) Surgical scar endometrioma. Surg Gynecol Obstet 177:243–246 Nirula R, Greaney GC (2000) Incisional endometriosis: an underappreciated diagnosis in general surgery. J Am Coll Surg 190:404–407. doi:10.1016/S1072-7515(99)00286-0 Rani PR, Soundararaghavan S, Rajaram P (1991) Endometriosis in abdominal scars—review of 27 cases. Int J Gynaecol Obstet 36:215–218. doi:10.1016/0020-7292(91)90716-I Wolf GC, Singh KB (1989) Cesarean scar endometriosis: a review. Obstet Gynecol Surv 44:89–95. doi:10.1097/00006254-198902000-00003 Witz CA (1992) Current concepts in the pathogenesis of endometriosis. Clin Obstet Gynecol 42:566–585. doi:10.1097/00003081-199909000-00013 Amato L, Coronella G, Berti S, Gallerani I, Moretti S, Fabbri P (2002) Successful treatment with doxycycline and nicotinamide of two cases of persistent pemphigoid gestations. J Dermatol Treat 13:143–146. doi:10.1080/09546630260199514 Purvis RS, Tyring SK (1994) Cutaneous and subcutaneous endometriosis. Surgical and hormonal therapy. J Dermatol Surg Oncol 20:693–695 Conflict of interest statement We declare that we have no conflict of interest. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Kurotsuchi, S., Iwase, A., Goto, M. et al. Scar endometriosis after a laparotomy for uterine perforation as a complication of dilatation and curettage. Arch Gynecol Obstet 279, 941–943 (2009). https://doi.org/10.1007/s00404-009-0963-x Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-009-0963-x

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Condition tags

endometriosis

MeSH descriptors

Cicatrix Dilatation and Curettage Endometriosis Laparotomy Uterine Perforation Adult Cicatrix Dilatation and Curettage Endometriosis Female Humans Laparotomy Uterine Perforation

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