An unusual case of laparoscopic appendicectomy scar site endometriosis

G. K. Poomalar, Poomalar Gunasekaran Kala, Nivetha Elumalai, Subhasri Sridharan, A. Bupathy
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2022 · vol. 11(8) , pp. 2274 · doi:10.18203/2320-1770.ijrcog20221953 · W4288051425
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This case report describes a rare instance of scar endometriosis at a laparoscopic appendectomy site in a 29-year-old woman, presenting as a painful, menstrually aggravated sub-umbilical mass.

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Abstract

Scar endometriosis following caesarean section is now becoming a relatively common complication. Endometriosis in the laparoscopic port site following appendicectomy is rare. Metaplasia theory probably explains the reason behind the formation of endometriosis following a non-gynecological procedure. We reported a case of scar endometriosis in the site of laparoscopic appendicectomy scar in a 29-year-old multiparous-women, who presented with pain and swelling in the sub-umbilical area getting aggravated during menstruation. A mass of 4×3×3 cm was found extending from the subcutaneous plane to the rectus muscle in the sub-umbilical region with underlying peritoneal involvement. There was no evidence of pelvic endometriosis. As surgical treatment remains the first line in scar endometriosis with the least recurrence rate, endometrioma excision was performed with one cm margin clearance all around. As complete excision with a wide margin was done, postoperative hormone prophylaxis is not required for her. Six months follow-up did not show any recurrence.
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An unusual case of laparoscopic appendicectomy scar site endometriosis DOI: https://doi.org/10.18203/2320-1770.ijrcog20221953Keywords: Scar endometriosis, Laparoscopic appendicectomy, ExcisionAbstract Scar endometriosis following caesarean section is now becoming a relatively common complication. Endometriosis in the laparoscopic port site following appendicectomy is rare. Metaplasia theory probably explains the reason behind the formation of endometriosis following a non-gynecological procedure. We reported a case of scar endometriosis in the site of laparoscopic appendicectomy scar in a 29-year-old multiparous-women, who presented with pain and swelling in the sub-umbilical area getting aggravated during menstruation. A mass of 4×3×3 cm was found extending from the subcutaneous plane to the rectus muscle in the sub-umbilical region with underlying peritoneal involvement. There was no evidence of pelvic endometriosis. As surgical treatment remains the first line in scar endometriosis with the least recurrence rate, endometrioma excision was performed with one cm margin clearance all around. As complete excision with a wide margin was done, postoperative hormone prophylaxis is not required for her. Six months follow-up did not show any recurrence. Metrics References Yıldırım D, Tatar C, Dogan O, Hut A, Donmez T, Akıncı M, et al. Post-caesarean scar endometriosis. Turk J Obstet Gynecol. 2018;15:33-8. Ananias P, Luenam K, Melo JP, Jose AM, Yaqub S, Turkistani A, et al. Cesarean Section: A Potential and Forgotten Risk for Abdominal Wall Endometriosis. Cureus. 2021;13(8):17410. Ding Y, Zhu J. A retrospective review of abdominal wall endometriosis in Shanghai, China. Int J Gynaecol Obstet. 2013;121(1):41-4. Ferrandina G, Paluzzi E, Fanfani F, Gentileschi S, Valentini AL, Mattoli MV, et al. Endometriosis-associated clear cell carcinoma arising in cesarean section scar: A case report and review of the literature. World J Surg Oncol. 2016;14(1):300. Chmaj-Wierzchowska K, Pieta B, Czerniak T, Opala T. Endometriosis in a post-laparoscopic scar-case report and literature review. Ginekologia Polska. 2014;85:386-9. Amini M, Moghbeli M. Appendectomy Scar Endometriosis: A Case Report. Middle East J Dig Dis. 2018;10(2):114-6. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012;98(3):511-9. Lagana AS, Garzon S, Gotte M, Vigano P, Franchi M, Ghezzi F. The Pathogenesis of Endometriosis: Molecular and Cell Biology Insights. Int J Mol Sci. 2019;20(22):5615. Akbulut S, Sevinc MM, Bakir S, Cakabay B, Sezginet A. Scar endometriosis in the abdominal wall: a predictable condition for experienced surgeons. Acta Chirurgica Belgica. 2010;110(3):303-7. Kinkel K, Frei KA, Balleyguier C, Chapron C. Diagnosis of endometriosis with imaging: a review. Eur Radiol. 2006;16(2):285-98. Pachori G, Sharma R, Sunaria RK, Bayla T. Scar endometriosis: Diagnosis by fine needle aspiration. J Cytol. 2015;32(1):65-67. Bektaş H, Bilsel Y, Sari YS, Ersöz F, Koç O, Deniz M, et al. Abdominal wall endometrioma; a 10-year experience and brief review of the literature. J Surg Res. 2010;164(1):e77-81. Wang PH, Juang CM, Chao HT, Yu KJ, Yuan CC, Ng HT. Wound endometriosis: risk factor evaluation and treatment. J Chin Med Assoc. 2003;66(2):113-9. Horton JD, Dezee KJ, Ahnfeldt EP, Wagner M. Abdominal wall endometriosis: a surgeon’s perspective and review of 445 cases. Am J Surg. 2008;196(2):207-12. Yela DA, Trigo L, Benetti-Pinto CL. Evaluation of cases of abdominal wall endometriosis at Universidade Estadual de Campinas in a period of 10 years. Rev Bras Ginecol Obstet. 2017;39(8):403-7. Sumathy S, Mangalakanthi J, Purushothaman K, Sharma D, Remadevi C, Sreedhar S. Symptomatology and Surgical Perspective of Scar Endometriosis: A Case Series of 16 Women. J Obstet Gynaecol India. 2017;67:218-23. Bozkurt M, Çil AS, Bozkurt DK. Intramuscular abdominal wall endometriosis treated by ultrasound-guided ethanol injection. Clin Med Res. 2014;12:160-5. Cope AG, Narasimhulu DM, Khan Z, VanBuren WM, Welch BT, Burnett TL. Nonsurgical radiologic intervention for management of abdominal wall endometriosis: A systematic review and meta-analysis. J Endometr Pelvic Pain Disord. 2020;12(1):41-50. Lee JS, Kim YJ, Hong GY, Nam SK, Kim TE. Abdominal wall endometriosis treatment by ultrasound-guided high-intensity focused ultrasound ablation: a case report. Gynecol Endocrinol. 2019;35:109-11. Nissotakis C, Zouros E, Revelos K, Sakorafas GH. Abdominal wall endometrioma: a case report and review of the literature. AORN J. 2010;91(6):730-42. Vuksic T, Rastovic P, Dragisic V. Abdominal wall endometrioma after laparoscopic operation of uterine endometriosis. Case reports in surgery. 2016;11:1-3.

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