Clinical characteristic analysis of 32 patients with abdominal incision endometriosis

Abstract

Medical records of 32 women with abdominal incision endometriosis who underwent surgical treatment in the Obstetrics and Gynaecology Hospital at Fudan University between September 1999 and March 2006 were reviewed retrospectively. All cases concerning the diagnosis of endometriosis were confirmed by two gynaecological pathologists. The median age was 32 years (range from 25 to 45). A total of 31 patients had a history of caesarean section, and one case underwent ovarian endometrioid cystectomy. All abdominal incision endometriosis presented with a mass in the abdominal scar. Among them, there were 30 patients who complained of cyclical pain during menses. All of the 32 cases underwent surgical treatment and had follow-up from 10 months to 6 years; there was no recurrence of endometriosis in 31 cases. Abdominal incision endometriosis is rare in women and most cases present following caesarean section. It is suggested that during caesarean section, precautions need to be taken to avoid transplantation of endometrium into the abdominal incision. Surgical treatment is recommended to excise the lesion completely. The frozen section is performed during the operation due to the possibility of malignancy in abdomen incision endometriosis.

Endometriosis externa within the rectus abdominis muscle

“…Endometriosis localized in the rectus abdominis muscle is rare. Although many theories have been suggested about the formation of endometriosis, one of the most popular theories for extra-genital endometriosis is the theory of vascular spread (7)(8)(9)(10)(11)(12)(13). According to this theory, endometrial cells reach extragenital regions through blood vessels or the lymphatic system resulting in endometriotic foci.…”

Scar endometriosis: A series of 3 cases

“…SE has been well documented in incisions where there is likelihood of contact with endometrial tissue, such as episiotomy, hysterectomy, hysterotomy, ectopic pregnancy, laparoscopic gynae surgeries, tubal ligation, and CS. 4,7,8 All our cases had occurrence of SE in post-cesarean scar.…”

“…An increase in the frequency of endometrioma has been reported in proportion to the increasing number of CS in recent years. 7 Major factor attributed to be responsible for endometrioma development is inadvertent inoculation of endometrial tissue into the incision site. 8 Clinically, SE presents as pain and swelling at the site of scar.…”

Endometrial Tumors in Postoperative Scars-Pathogenesis, Diagnostics and Treatment

“…If the endometriosis is incorporated into the musculature, en bloc resection of all the myofascial elements is recommended and often mesh repair of the abdominal wall is necessary (1, 29,43,59). Figures 1 -6 illustrate the procedure in such a case of 15 cm endometrioma in Bytom clinical centre.…”

“…A surgical resection with complete and wide negative margins is the treatment of choice of endometriotic lesions in the abdominal wall, taking into account the risk of recurrence and the potential for their malignant transformation (1, 8,12,13,28,29,43,59). If the endometriosis is incorporated into the musculature, en bloc resection of all the myofascial elements is recommended and often mesh repair of the abdominal wall is necessary (1, 29,43,59).…”