The Effect of Diagnosis and Surgical Margin Safety on the Success of Treatment in Endometriomas after Cesarean Section

Nihat Gülaydın
In: Istanbul Medical Journal · 2022 · vol. 23(2) , pp. 131–134 · doi:10.4274/imj.galenos.2022.94220 · W4281667754
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study investigated how diagnosis and surgical margin safety affect the success of treating endometriomas that develop after cesarean sections.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This retrospective study (2001–2021) evaluated 14 patients with a painful abdominal wall mass at the cesarean scar site who ultimately had pathology-confirmed endometriosis externa, assessing clinical features, imaging (ultrasonography and/or CT), diagnostic workup (including tru-cut biopsy in 4 cases), surgical details, and follow-up outcomes. The preliminary radiologic diagnoses commonly included other entities (e.g., desmoid tumor, foreign body reaction, granuloma, abscess), but all patients underwent primary mass excision with a reported surgical margin of at least 10 mm, with repair by primary closure in most and prolene mesh in one case; postoperative pathology in all cases confirmed endometriosis externa. No recurrences were observed for follow-up of 1 year or longer, except for one patient with suspected recurrence who had fibrosis on further pathology. Limitations explicitly noted were the small sample size and retrospective design with documentation constraints. This paper is centrally about endometriosis — it focuses on diagnosis and surgical margin considerations for treatment success in post-cesarean endometriomas/endometriosis externa.

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Abstract

Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity (1). It has been reported that the incidence of endometriosis in women of reproductive age is around 5-15% (2). Endopelvic endometriosis; it develops more frequently in different structures such as ovaries, uterosacral ligaments, pelvic peritoneum, recto-uterine pouch, cervix, vagina and round ligament. It is rarely observed in extrapelvic structures such as the abdominal wall, urinary and gastrointestinal tract, skin, brain and lungs (3,4). Many theories have been proposed regarding the development of endometriosis. These theories include retrograde menstruation, metaplasia, venous-lymphatic metastasis, and mechanical implantation into the incision scar during surgery. The most common operations leading to endometriosis include hysterectomy, cesarean section, amniocentesis and episiotomy (5). The most common finding is palpable painful mass at the cesarean scar site during menstruation (6). The patient's history and physical examination are the most valuable steps for diagnosis. Various examination methods such as ultrasonography (USG), computed tomography (CT), magnetic resonance, Doppler sonography and fine needle biopsy can be used as advanced examinations (7,8). Surgical resection of endometriosis externa remains the treatment of choice to prevent recurrence of the disease. The resection of a mass with a surgical margin of at least 10 mm is accepted as the best clinical practice (9,10).

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endometriosis

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