An unusual case of endometrial trocar site implantation

Martinez-Serna, Tomas; Stalter, Kenneth D.; Filipi, Charles J.; Tomonaga, Tetsuya

doi:10.1007/s004649900763

Cited by 16 publications

(16 citation statements)

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“…It can be observed after Cesarean section [2,3] and after episiotomy at the perineal site [4]. Surgical scar endometriosis at the trocar site has been described to be associated with the use of laparoscopic surgery as a method for treatment [5,6]. In our case, a symptomatic lesion was observed to develop three years after her laparoscopic hysterectomy, yet there was no endometriosis lesion noted at that time.…”

Section: Discussionmentioning

confidence: 66%

“…The infl uence of surgical tumor manipulation and the resultant shedding of tumor cells has been observed [7]. It has also been suggested that localized tissue ischemia renders that tissue conductive to implantation [6]. Several authors have hypothesized that the practice of insuffl ating CO 2 into the peritoneal cavity causes cell aerosolization and may promote tumor cell shedding [5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…It has also been suggested that localized tissue ischemia renders that tissue conductive to implantation [6]. Several authors have hypothesized that the practice of insuffl ating CO 2 into the peritoneal cavity causes cell aerosolization and may promote tumor cell shedding [5][6][7][8]. A higher probability of tumor growth on the peritoneum has been associated with gas laparoscopy as opposed to gasless laparoscopy procedures [7,8].…”

Section: Discussionmentioning

confidence: 99%

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A case of trocar site implantation of endometriosis three years after laparoscopic hysterectomy

Lee

Lim

Shin

et al. 2012

Korean J Obstet Gynecol

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We present the case of a 42-year-old woman who had undergone laparoscopic hysterectomy for uterine myoma three years prior to diagnosis with trocar site endometriosis. The patient was observed to suffer endometrial implant exclusively at the suprapubic trocar site. This case demonstrated that trocar site endometriosis can occur, even in a patient without a uterus and without previous endometriosis. The etiopathogenesis of this condition was likely attributed to the dissemination of endometrial tissue during laparoscopic surgery, resulting in subsequent microscopic endometriosis cell implantation in the trocar site.Keywords: Endometriosis; Laparoscopy; Implantation Received: 2011.12.19. Revised: 2012 Th is is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2012. Korean Society of Obstetrics and GynecologyEndometriosis is a condition whereby functional endometrial tissue is present outside the uterine cavity. The disease commonly affects the pelvis with the most common locations being the ovaries, urine ligaments, rectovaginal septum and peritoneum. Unusual endometriosis outside the pelvis has been reported to include the bladder, intestines, appendix, hernia sacs, lungs, kidneys and other extremities. It well known that endometriosis may migrate and implant in various anatomic locations including surgical scars [1]. Herein, we report the rare case of a patient who had undergone a laparoscopic hysterectomy for uterine myoma three years prior to a diagnosis of trocar site endometriosis. Case ReportA 42 year old woman presented an approximately 3 cm sized mass in the suprapubic region at the site of trocar insertion, accompanied by cyclic pain which had commenced eight months prior to her visit. The patient had undergone two Cesarean sections, ten and twelve years prior to her visit, as well as a laparoscopic subtotal hysterectomy which was applied at a private clinic in order to treat a large uterine myoma three years prior to her visit. According to the private clinic, she did not report pelvic pain, dysmenorrhea or dyspareunia prior to the hysterectomy. And besides the uterine myoma, no other abnormal operative fi ndings were observed during the hysterectomy. Our physical examination revealed an approximately 5 cm sized, non-tender mass, accompanied with slight swelling, located in the suprapubic region just beneath the suprapubic trocar site scar. Ultrasonography revealed a 5.5 × 2.2 cm, oval-shaped, hypoechoic mass in the abdominal wall of the suprapubic region. No abnormal findings were observed in the pelvis or ovaries (Fig. 1). Routine clinical laboratory test results were all within normal limits except for CA-125, which was slightly above normal range at 45.4 IU/mL. Based on these findings and symptoms, granulomas due to surgical wounds or CASE REP...

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A case of trocar site implantation of endometriosis three years after laparoscopic hysterectomy

Lee

Lim

Shin

et al. 2012

Korean J Obstet Gynecol

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“…16 In searches of the PubMed, Google Scholar, and Medline databases using the search terms ''endometriosis,'' ''scar endometriosis,'' ''abdominal wall endometriosis,'' and ''trocar,'' alone and in various combinations, we found 14 English-language articles on trocar site endometriosis. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] Table 1 summarizes the data from the 10 articles (13 patients) for which we obtained the full text.…”

Section: Case Reportmentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18] This study presents the case of a patient with endometriotic trocar site metastasis who had previously undergone laparoscopic resection of a left ovarian endometriotic cyst.…”

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confidence: 99%

Laparoscopic Trocar Port Site Endometriosis: A Case Report and Brief Literature Review

Emre

Akbulut

Yilmaz

et al. 2012

International Surgery

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Endometriosis is defined as the presence of ectopic endometrial tissue outside the lining of the uterine cavity. It occurs most commonly in pelvic sites such as ovaries, cul-de-sac, and fallopian tubes but also can be found associated with the lungs, bowel, ureter, brain, and abdominal wall. Abdominal wall endometriosis, also known as scar endometriosis, is extremely rare and mainly occurs at surgical scar sites. Although many cases of scar endometriosis have been reported after a cesarean section, some cases of scar endometriosis have been reported after an episiotomy, hysterectomy, appendectomy, and laparoscopic trocar port tracts. To our knowledge, 14 case reports related to trocar site endometriosis have been published in the English language literature to date. Herein, we present the case of a 20-year-old woman (who had been previously operated on for left ovarian endometrioma 1.5 years ago by laparoscopy) with the complaint of a painful mass at the periumbilical trocar site with cyclic pattern. Consequently, although rare, if a painful mass in the surgical scar, such as the trocar site, is found in women of reproductive age with a history of pelvic or obstetric surgery, the physician should consider endometriosis.

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