Scar Endometriosis in a Patient With Bladder Exstrophy

Abstract

Endometriosis is an ectopic occurrence of tissue morphologically and functionally resembling endometrial tissue in regions outside the uterine cavity. Although scar endometriosis after surgery has been shown to be most common among all the extrapelvic forms of endometriosis, endometriosis after bladder exstrophy surgery has not been reported, and here we present the first known case. A 26-year-old woman with a history of bladder exstrophy was aware of a painful induration at the operative scar located in the left lower abdominal wall, and presented at our hospital. Although the symptoms resolved, recurring exacerbation was observed after 9 months. Abdominal magnetic resonance imaging showed a heterogeneous mass 16 mm in diameter in the left abdominal wall with high signal intensity on T1W1 and T2W1 images. She underwent excisional biopsy of the lesion under general anesthesia. Histopathology confirmed the diagnosis of endometriosis. Eighteen months after surgery, she was well and free from recurrence.

Letter to the Editor re: Vieira et al. Abdominal wall endometriosis. J Clin Urol 2017; 10(4): 376–78

“…3 Kitajima et al in 2013 also reported a case in an exstrophy patient, but unlike our case the patient complained of pain. 4 We agree with the authors that the presentation may be atypical and that a significant time lag may exist between surgery and onset of symptoms. Although normal vaginal delivery has been reported in exstrophy patients, Caesarean section is recommended.…”

“…1 It should be acknowledged by the authors that in females with a past history of bladder exstrophy abdominal wall endometriosis has been reported twice. 3,4 In 2014 we described a case in a 29-year-old female who underwent primary bladder closure in the first week of life and who subsequently presented with a painless abdominal swelling that was unrelated to her menses. 3 Kitajima et al in 2013 also reported a case in an exstrophy patient, but unlike our case the patient complained of pain.…”

“…It should be acknowledged by the authors that in females with a past history of bladder exstrophy abdominal wall endometriosis has been reported twice. 3,4…”

“…3 Kitajima et al in 2013 also reported a case in an exstrophy patient, but unlike our case the patient complained of pain. 4…”

Abdominal Wall Endometriosis Eleven Years After Cesarean Section: Case Report

“…A case of AWE at the site of trocar during laparoscopic removal of ovarian endometrioma has also been reported 7 . Kitajima et al describe a case of AWE in a 26-year-old female with a history of surgery related to bladder extrophy in her neonatal and infantile periods 8 . Kodandapani et al describe a case of umbilical scar endometriosis following laparoscopicassisted vaginal hysterectomy 9 .…”