Risk Factors, Clinical Presentation, and Outcomes for Abdominal Wall Endometriosis

Zaraq Khan, Khan Z, Zanfagnin V, Valentina Zanfagnin, Sherif A El-Nashar, Sherif A. El‐Nashar, Abimbola O Famuyide, Gaurang S Daftary, Daftary GS, Matthew R Hopkins, Hopkins MR
Journal of minimally invasive gynecology · 2017 · vol. 24(3) , pp. 478–484 · doi:10.1016/j.jmig.2017.01.005 · PMID:28104496 · W2573017223
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This paper investigated the risk factors, clinical presentation, and outcomes associated with abdominal wall endometriosis.

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Abstract

Study objectiveTo evaluate the risk factors, presentation, and outcomes in cases of abdominal wall endometriosis.DesignA case-control study (Canadian Task Force classification II-2).SettingAn academic medical center.PatientsA total of 102 (34 cases and 68 controls) were included.InterventionsSurgical resection of abdominal wall endometriosis.Measurements and main resultsCases underwent surgical excision for abdominal wall endometriosis at Mayo Clinic from January 1, 2000, through December 31, 2013. For each case, 2 controls were randomly selected from a list of women who had surgery in the same year with minimal (American Society for Reproductive Medicine stage I-II) endometriosis. A chart review was completed for variables of interest. Regression models were used to identify independent risk factors associated with abdominal wall endometriosis.ResultsIn 14 years, 2539 women had surgery for endometriosis at Mayo Clinic. Of these, only 34 (1.34%) had abdominal wall endometriosis. The mean age was 35.2 ± 5.9 years, and the median parity was 2 (range, 0-5). Clinical examination diagnosed abdominal wall endometriosis in 41% of cases, with the cesarean delivery scar being the most common site (59%). There was a strong correlation between the size of the lesion on clinical examination compared with the size of the pathology specimen (r2 = 0.74, p < .001). When compared with controls, cases had significantly higher parity and body mass index, more cyclic localized abdominal pain, less dysmenorrhea, longer duration from the start of symptoms to surgery, and more gynecologic surgeries for symptoms without cure. In the final multivariable model, cyclic localized abdominal pain, absence of dysmenorrhea, and previous laparotomy were independently associated with abdominal wall endometriosis with adjusted odds ratios of 10.6 (95% CI 1.85-104.4, p < .001), 12.4 (95% CI 1.64-147.1, p < .001), and 70.1 (95% CI 14.8-597.7, p < .001), respectively, with an area under the curve for the receiver operating characteristic of 0.94 (95% CI, 0.87-0.98). After excision of the disease, repeat surgery was needed in 2 (5.9%) patients with a median time to recurrence of 50.5 (range, 36-65) months.ConclusionsAbdominal wall endometriosis is a rare but unique form of endometriosis. Careful history and clinical examination can provide accurate diagnosis and avoid unnecessary delay before surgical intervention. Localized cyclic abdominal pain with the absence of dysmenorrhea and a history of prior laparotomy are independent risk factors with very high accuracy for diagnosis.

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Condition tags

endometriosis

MeSH descriptors

Abdominal Wall Endometriosis Endometriosis Abdominal Pain Abdominal Pain Abdominal Wall Abdominal Wall Adult Case-Control Studies Cesarean Section Cesarean Section Cicatrix Cicatrix Endometriosis Endometriosis Female Gynecologic Surgical Procedures Gynecologic Surgical Procedures Humans Laparotomy

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