[Abdominal wall endometriosis after caesarean section: report of fifteen cases]

G. Picod, Picod G, Boulanger L, L. Boulanger, Bounoua F, F. Bounoua, F. Leduc, Leduc F, G Duval, Duval G
Gynecologie, obstetrique & fertilite · 2006 · vol. 34(1) , pp. 8–13 · doi:10.1016/j.gyobfe.2005.11.002 · PMID:16406732 · W2041715841
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This case series examines fifteen instances of parietal endometriosis occurring in cesarean section scars, detailing their presentation and management.

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Abstract

OBJECTIVE: Parietal endometriosis is an uncommon pathology. It can occur on all the scars, most often after a surgical procedure with hysterotomy. Surgical scar endometriosis following caesarean section has an incidence of 0.03 to 0.4%. PATIENTS AND METHODS: This retrospective study reviewed all the cases of parietal endometriosis seen during a 7-year period in the department of visceral surgery of the Armentière's hospital center. A pathological analysis has confirmed each lesion retained. RESULTS: 15 women were treated during this period. The mean age is 32 years. All the women have one or two antecedents of caesarean with Pfannenstiel's laparotomy. The interval between the caesarean and the appearance of the first symptoms is on average of 5 years and 11 months. Only 66.6% of cases presented the classical symptoms with cyclic pain. For 66.6% of patients, the diagnosis of parietal endometriosis was suspected before the treatment. The treatment is a surgical one with exeresis for all the women. In 13.3% of the cases, the lesion is pre aponeurotic. In 46.6% of the cases, it overgrows the rectus abdominis muscle, in 33.3% of the cases the external abdominal oblique and at last a lesion overgrows the transversus abdominis and one is in an inguinal localization. The mean size of lesions is 2.48 cm. We have not notified complications and no recurrence was noted. DISCUSSION AND CONCLUSION: The local endometrial cell transplant is the most likely mechanism to explain the physiopathology of parietal endometriosis. The classical symptoms associate a painful swelling and cyclic pain related to the menstrual period, but all of these symptoms are not always associated. The contribution to the diagnosis of the imaging studies is weak. The surgical treatment has to be sufficiently wide to avoid all recurrence. No means of prevention has proved its efficiency. In 26.6% of cases the parietal endometriosis is associated to pelvic endometriosis. This localization is more often asymptomatic. Then the realization of a laparoscopic exploration is not indicated immediately.

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Condition tags

endometriosis

MeSH descriptors

Abdominal Wall Abdominal Wall Cesarean Section Endometriosis Postoperative Complications Abdominal Pain Abdominal Pain Abdominal Pain Adult Adult Cesarean Section Cesarean Section Endometriosis Endometriosis Endometriosis Endometriosis Female Female Humans Humans

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