The clinical characteristics and surgical approach of scar endometriosis: A case series of 14 women

The clinical characteristics and surgical approach of scar endometriosis: A case series of 14 women DOI: https://doi.org/10.17305/bjbms.2018.2659Keywords: Abdominal wall endometriosis, cesarean section, surgeryAbstract Scar endometriosis, also referred to as abdominal wall endometriosis (AWE), is a rare form of endometriosis that usually develops in the scar after obstetric or gynecological surgeries, including cesarean section (CS). Recently, the occurrence of scar endometriosis has been increasing together with the increase of CS incidence. Scar endometriosis can be clinically misdiagnosed as hernia, lipoma, or hematoma. Here we retrospectively analyzed the clinical aspects of scar endometriosis and surgical approach in 14 patients from a tertiary hospital, who were treated by surgery, between 2012 and 2017. The mean age was 32.71 ± 8.61 years (range: 19–45). Palpable mass and cyclic pain at the scar site were the most common complaints. Twelve patients had previously undergone CS, and two patients had undergone a surgery of ovarian endometrioma. The preoperative diagnosis was determined with ultrasonography (US), magnetic resonance imaging (MRI), or computed tomography (CT). Preoperatively, scar endometriosis was diagnosed in 12/14 patients (85.7%), while 2 patients (14.3%) were diagnosed with inguinal hernia. The treatment was surgical excision in all patients; in addition, mesh repair surgery was performed in 1 patient with recurrent scar endometriosis. Postoperatively, endometriosis was confirmed by histology in all patients. The average size of endometriomas was 24.71 ± 6.67 mm (range: 11–35). No woman had concurrent pelvic endometriosis. In the follow-up period (mean: 9 months) the recurrence of endometriosis was not observed. Scar endometriosis should be considered in all women of reproductive age presenting with cyclic pain and swelling in their abdominal incision sites. Citations Downloads References Nezhat FR, Shamshirsaz AA, Yildirim G. Pelvic pain, endometriosis, and the role of the gynecologist. In: Altcheck A, Deligdisch L editors. Pediatric, Adolescent and Young Adult Gynecology. 1st ed. New Jersey: Wiley-Blackwell; 2009. p. 174-94. https://doi.org/10.1002/9781444311662.ch20. Alessandro P, Luigi N, Felice S, Maria PA, Benedetto MG, Stefano A. Research development of a new GnRH antagonist (Elagolix) for the treatment of endometriosis: A review of the literature. Arch Gynecol Obstet 2017;295(4):827-32. https://doi.org/10.1007/s00404-017-4328-6. De Cicco Nardone C, Terranova C, Plotti F, Ricciardi R, Capriglione S, Luvero D, et al. The role of ovarian fossa evaluation in patients with ovarian endometriosis. Arch Gynecol Obstet 2015;292(4):869-73. https://doi.org/10.1007/s00404-015-3719-9. Bratu D, Chicea R, Ciprian T, Beli L, Dan S, Mihetiu A, et al. A rare case of ileus caused by ileum endometriosis. Int J Surg Case Rep 2016;26:24-6. https://doi.org/10.1016/j.ijscr.2016.06.023. Maillot J, Brun JL, Dubuisson V, Bazot M, Grenier N, Cornelis FH. Mid-term outcomes after percutaneous cryoablation of symptomatic abdominal wall endometriosis: Comparison with surgery alone in a single institution. Eur Radiol 2017;27(10):4298-306. https://doi.org/10.1007/s00330-017-4827-7. 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. https://doi.org/10.1016/j.amjsurg.2007.07.035. Zhao X, Lang J, Leng J, Liu Z, Sun D, Zhu L. Abdominal wall endometriomas. Int J Gynaecol Obstet 2005;90(3):218-22. https://doi.org/10.1016/j.ijgo.2005.05.007. Chang Y, Tsai EM, Long CY, Chen YH, Kay N. Abdominal wall endometriosis. J Reprod Med 2009;54(3):155-9. Nominato NS, Prates LF, Lauar I, Morais J, Maia L, Geber S. Caesarean section greatly increases risk of scar endometriosis. Eur J Obstet Gynecol Reprod Biol 2010;152(1):83-5. https://doi.org/10.1016/j.ejogrb.2010.05.001. Blanco RG, Parithivel VS, Shah AK, Gumbs MA, Schein M, Gerst PH. Abdominal wall endometriomas. Am J Surg 2003;185(6):596-8. https://doi.org/10.1016/S0002-9610(03)00072-2. Dirican A, Unal B, Ozgor D, Unal D, Isik B, Piskin T, et al. Rektus abdominus kasında endometriosis: Olgu sunumu (Endometriosis in rectus abdominis muscle: A case report). Journal of Inonu University Medical Faculty 2008;15(1):55-7. Khachani I, Filali Adib A, Bezad R. Cesarean scar endometriosis: An uncommon surgical complication on the rise? Case report and literature review. Case Rep Obstet Gynecol 2017;8062924. https://doi.org/10.1155/2017/8062924. Halban J. Metastatic hysteroadenosis. Wien Klin Wochenschr 1924;37:1205-6. Ozel L, Sagiroglu J, Unal A, Unal E, Gunes P, Baskent E, et al. Abdominal wall endometriosis in the cesarean section surgical scar: A potential diagnostic pitfall. J Obstet Gynaecol Res 2012;38(3):526-30. https://doi.org/10.1111/j.1447-0756.2011.01739.x. Patterson GK, Winburn GB. Abdominal wall endometriomas: Report of eight cases. Am Surg 1999;65(1):36-9. Khan Z, Zanfagnin V, El-Nashar SA, Famuyide AO, Daftary GS, Hopkins MR. Risk factors, clinical presentation, and outcomes for abdominal wall endometriosis. J Minim Invasive Gynecol 2017;24(3):478-84. https://doi.org/10.1016/j.jmig.2017.01.005. Oh EM, Lee WS, Kang JM, Choi ST, Kim KK, Lee WK. A surgeon's perspective of abdominal wall endometriosis at a caesarean section incision: Nine cases in a single institution. Surg Res Pract 2014;2014:765372. https://doi.org/10.1155/2014/765372. Medeiros Fd, Cavalcante DI, Medeiros MA, Eleutério J Jr. Fine-needle aspiration cytology of scar endometriosis: Study of seven cases and literature review. Diagn Cytopathol 2011;39(1):18-21. https://doi.org/10.1002/dc.21319. Yu CY, Perez-Reyes M, Brown JJ, Borrello JA. MR appearance of umbilical endometriosis. J Comput Assist Tomogr 1994;18(2):269-71. https://doi.org/10.1097/00004728-199403000-00019. Purvis RS, Tyring SK. Cutaneous and subcutaneous endometriosis. Surgical and hormonal therapy. J Derm Surg Oncol 1994;20(10):693-5. https://doi.org/10.1111/j.1524-4725.1994.tb00456.x. Dibble EH, D'Amico KC, Bandera CA, Littrup PJ. Cryoablation of abdominal wall endometriosis: A minimally invasive treatment. AJR Am J Roentgenol 2017;209(3):690-6. https://doi.org/10.2214/AJR.16.17269. Ince C, Wagner A, Rajakumar C. Abdominal wall endometriosis. J Obstet Gynaecol Can 2017. pii: S1701-2163(17)30202-5. https://doi.org/10.1016/j.jogc.2017.03.107. Pas K, Joanna SM, Renata R, Skret A, Barnas E. Prospective study concerning 71 cases of caesarean scar endometriosis (CSE). J Obstet Gynaecol 2017;37(6):775-8. Downloads Additional Files Published Issue Section Categories How to Cite Accepted 2017-12-23 Published 2018-08-01