A Case of Post-Caesarean Scar Endometrioma

İlyas Erken, Gizem Limnili, Nilgün Özçakar
Turkish Journal of Family Medicine and Primary Care · 2017 · pp. 139 · doi:10.21763/tjfmpc.318067 · W2621373709
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A cesarean scar mass developing two years post-operation was diagnosed as endometriosis after extensive excision, highlighting its consideration in differential diagnoses for abdominal masses in reproductive-age women.

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This case report describes a patient who developed a mass at the site of a previous cesarean section scar two years post-surgery. The lesion was extensively excised, and subsequent pathological analysis confirmed the diagnosis of endometriosis within the scar tissue. The authors emphasize that clinicians should consider endometriosis in the differential diagnosis for abdominal wall masses in reproductive-age women, particularly when symptoms correlate with menstruation and there is a history of gynecologic surgery. This paper is centrally about endometriosis — specifically, it details the clinical presentation, diagnosis, and surgical management of a rare cesarean scar endometrioma.

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Abstract

Scar endometriosis is a rare disease after an abdominal surgery which is difficult to diagnose. Caesarean section scar endometriosis is a rare occurance with reported different incidences. The diagnosis is frequently made after excision of the lesion. In this case, a cesarean scar site mass was detected two years after the cesarean operation. The pathological diagnosis of the mass which was extensively excised was determined as endometriosis. Endometriosis should be kept in mind in the differential diagnosis of the masses found in the front wall of the sac in reproductive age women. This diagnosis must be supported by the presence of past gynecologic operations and symptoms associated with menstruation. In family medicine, it is important to keep in mind the rare and specific diseases as well as diseases that are common in the society. Skar endometriyozis, abdominal cerrahiler sonrası seyrek görülen ve tanı konması güç bir durumdur. Sezaryen sonrası skar dokusunda endometriyozis ise nadiren görülmekte olup, yapılan çalışmalarda farklı oranlar bildirilmektedir. Tanı, çoğunlukla lezyonun eksizyonu ile konur. Bu olguda, sezaryen operasyonundan iki yıl sonra, sezaryen skar yerinde kitle geliştiği saptandı. Geniş eksizyonla çıkarılan kitlenin patolojik tanısı, endometriyozis olarak belirlendi. Üreme çağındaki kadınlarda, batın ön duvarında bulunan kitlelerin ayırıcı tanısında endometriyozis akılda tutulmalıdır. Geçirilmiş jinekolojik operasyon varlığı ve semptomların adet dönemleri ile ilişkili olması ile de bu tanı desteklenmektedir. Aile hekimliğinde, toplumda sık görülen hastalıkların yanı sıra, nadir ve özellikli hastalıkları da akılda tutarak hizmet verilmesi önemlidir.
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Abstract

Scar endometriosis is a rare disease after an abdominal surgery which is difficult to diagnose. Caesarean section scar endometriosis is a rare occurance with reported different incidences. The diagnosis is frequently made after excision of the lesion. In this case, a cesarean scar site mass was detected two years after the cesarean operation. The pathological diagnosis of the mass which was extensively excised was determined as endometriosis. Endometriosis should be kept in mind in the differential diagnosis of the masses found in the front wall of the sac in reproductive age women. This diagnosis must be supported by the presence of past gynecologic operations and symptoms associated with menstruation. In family medicine, it is important to keep in mind the rare and specific diseases as well as diseases that are common in the society. Skar endometriyozis, abdominal cerrahiler sonrası seyrek görülen ve tanı konması güç bir durumdur. Sezaryen sonrası skar dokusunda endometriyozis ise nadiren görülmekte olup, yapılan çalışmalarda farklı oranlar bildirilmektedir. Tanı, çoğunlukla lezyonun eksizyonu ile konur. Bu olguda, sezaryen operasyonundan iki yıl sonra, sezaryen skar yerinde kitle geliştiği saptandı. Geniş eksizyonla çıkarılan kitlenin patolojik tanısı, endometriyozis olarak belirlendi. Üreme çağındaki kadınlarda, batın ön duvarında bulunan kitlelerin ayırıcı tanısında endometriyozis akılda tutulmalıdır. Geçirilmiş jinekolojik operasyon varlığı ve semptomların adet dönemleri ile ilişkili olması ile de bu tanı desteklenmektedir. Aile hekimliğinde, toplumda sık görülen hastalıkların yanı sıra, nadir ve özellikli hastalıkları da akılda tutarak hizmet verilmesi önemlidir.

Keywords

References - 1. Macer ML, Taylor HS. Endometriosis and infertility: A review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am 2012;39(4):535–549. - 2. Oral E, Api M, Ata B, Kumbak Aygün B, Berker B, Biberoğlu KÖ, et al. Türkiye endometriyozis tanı ve yönetim kılavuzu. Turkiye Klinikleri J Gynecol Obst-Special Topics 2016;9(2):80-112. - 3. Gabriel A, Shores JT, Poblete M, Victorio A, Gupta S. Abdominal wall endometrioma. Ann Plast Surg 2007;58 (6):691-693. - 4. Nominato NS, Prates LFVP, Lauar I, Morais J, Maia L, Geber S. Caesarean section greatly increases risk of scar endometriosis. European Journal of Obstetrics & Gynecology and Reproductive Biology 2010; 152:83–85. - 5. Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat. Rev. Endocrinol. 2014;10(5):261–275. - 6. Zhao X, Lang J, Leng J, Liu Z, Zhu L. Abdominal Wall Endometriomas. Int J Gynaecol Obstet 2005;90(3):218-22. - 7. Khetan N, Torkington J, Watkin A, Jamison MH, Humphreys WV. Endometriosis: presentation to general surgeons. Ann R Coll Surg Engl 1999;81: 255-259. - 8. Hickey M, Ballard K, Farquhar C. Endometriosis. BMJ 2014;348:g1752. Details Primary Language Turkish Subjects - Journal Section Case Report Authors İlyas Erken This is me Sinop erfelek ilçe hastanesi Türkiye Gizem Limnili This is me Dokuz Eylül Üniversitesi, Medikososyal Hizmet Birimi, İzmir Türkiye Nilgün Özçakar Dokuz Eylül Üniversitesi, Aİle Hekimliği Anabilim Dalı, İzmir Türkiye Publication Date June 20, 2017 Submission Date June 1, 2017 Acceptance Date March 9, 2017 Published in Issue Year 2017 Volume: 11 Number: 2

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