Umbilical endometriosis after unprotected removal of uterine pieces through the umbilicus

Koninckx, Philippe; Donders, Gilbert; Vandecruys, H.

doi:10.1016/s1074-3804(00)80045-6

Cited by 31 publications

(24 citation statements)

References 33 publications

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“…In cases with previous surgery, umbilical endometriosis should be defined as secondary umbilical endometriosis, which is more common than PUE, and is most likely due to iatrogenic direct seeding of the endometrial cells, either during laparoscopic or open surgical procedures. [9] The theory of lymphatic or vascular dissemination is favoured in the case of umbilical endometriosis with coexisting pelvic endometriosis. [10,11] The etiology of PUE remains unclear; however, several etiological theories have been proposed: these include coelomic metaplasia of the urachus remnant; direct extension through the round ligament; or congenital presence of developmentally displaced endometrial tissue.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] Cutaneous and umbilical endometriosis may occur in patients following gynaecological surgery or a caesarean section, owing to direct seeding after laparotomy or laparoscopy. [9] The theory of lymphatic or vascular dissemination is favoured in the case of umbilical endometriosis with coexisting pelvic endometriosis. [10,11] Primary umbilical endometriosis (PUE) is very rare, and not related to previous gynecological surgery or caesarean section.…”

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Primary umbilical endometriosis: To scope or not to scope?

Chrysostomou

Branch

2017

S Afr J OG

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RESEARCHBackground. Primary umbilical endometriosis (PUE) is a rare condition affecting 0.5 -1% of all cases of extragenital endometriosis. The method of using routine laparoscopic inspection of the pelvis to exclude pelvic endometriosis has been applied extensively over the years. It has been demonstrated that even patients who have had no previous pelvic surgery or caesarean section, and have no symptoms of pelvic endometriosis or history of infertility, have presented with this condition. Objective. To investigate whether patients with PUE should always undergo a laparoscopy to exclude pelvic endometriosis. Methods. The study included women presenting with a history of painful umbilical nodules or bleeding from the umbilical nodule during or after menstruation in the absence of previous surgery either for gynecological disorders or caesarean section. The study began in January 2010 and ended in December 2016. All patients underwent umbilical biopsy confirming the presence of umbilical endometriosis before the diagnostic laparoscopy took place. Results. Fourteen patients with cutaneous (scar) and umbilical endometriosis attended the clinic during the study period. Of these, only six cases (42.8%) met the inclusion criteria of PUE clinically, and underwent diagnostic laparoscopy. Their mean age was 31.1 years (range 23 -48), and the mean parity was 1.1 (range 0 -3), with no history of previous pelvic surgery or caesarean section. Biopsies of the lesions confirmed the presence of endometrial tissue (gland and stroma) and haemorrhage. Diagnostic laparoscopy that took place immediately after the excision of umbilical endometriosis revealed no pelvic endometriosis. Conclusion. A laparoscopy to exclude pelvic endometriosis should not be undertaken in patients who present with PUE, as there is a potential risk of introducing endometriosis into the pelvic cavity. Additionally, there is a risk of exposing the patient to unnecessary intervention and possible complications associated with the procedure. Endometriosis is defined by the presence of functional endometrial glands and stroma outside the endometrial cavity. It is a common gynaecological condition that affects up to 22% of all women (8 -15% of women of reproductive age, and 6% of premenopausal women). [1,2] The aetiology of endometriosis remains unclear; it is considered to be a 'disease of theories' , with its pathophysiology only partially understood. Endometriosis usually occurs within the pelvic cavity. Common locations are the uterine wall, the fallopian tubes, the ovaries and the pelvic peritoneum. [3][4][5] Pelvic endometriosis presents clinically with a triad of symptoms: pain (chronic pelvic pain and dysmenorrhea), menorrhagia and infertility. S Afr J Obstet GynaecolExtrapelvic endometriosis affects up to 15% of patients, and can be found in almost all the organs (such as bowel, bladder, pericardium, pleura and even the brain). Extrapelvic endometriosis has varied signs and symptoms depending on the location. [6][7][8] Cutaneous and umbilical endometri...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Primary umbilical endometriosis: To scope or not to scope?

Chrysostomou

Branch

2017

S Afr J OG

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“…Se agregan a éstas las más recientes que atribuyen un rol a ciertos déficits inmunológicos que predisponen a las pacientes a desarrollar endometriosis. Existen varios reportes de implantes endometriósicos en relación a incisiones de cesáreas o episiotomías y en sitios de inserción de trocares de laparoscopia (4,5,6) Pensamos que existen dos explicaciones teó-ricas para el hallazgo de trozos de útero (morcelomas o restos de miometrio y endometrio post morcelación) y endometriosis en estas pacientes: la primera es que existiera una endometriosis microscópica al momento de la cirugía inicial, pero esta posibilidad nos parece poco probable esencialmente porque el reporte de anatomía patológi-ca no mostró ninguna lesión de endometriosis en ese momento. La segunda explicación y la más plausible desde nuestro punto de vista, es la siembra de tejido endometrial y miometrial viable en la pelvis, en el momento de la morcelación uterina.…”

Section: Discussionunclassified

Hallazgo De Fragmentos Uterinos Intrabdominales Poshisterectomía

et al. 2010

Rev. chil. obstet. ginecol.

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RESUMENSe presentan los casos de tres pacientes en su quinta década de vida que fueron sometidas a histerectomía por miomas uterinos sintomáticos. Caso 1: Paciente sometida a histerectomía supracervical laparoscópica. El cuerpo uterino fue extraído del abdomen mediante morcelación eléctrica. Cuatro años después presenta intenso dolor pélvico cíclico que requiere hospitalizaciones. La resonancia magnética sugiere nódulos vascularizados en pelvis. Se efectúa laparotomía diagnóstica resecándose implantes de tejido miometrial y endometrio en pelvis. Caso 2: Paciente sometida a histerectomía subtotal laparoscopica hace 12 años por miomatosis uterina. Consulta por dolor en fosa iliaca izquierda con exacerbación cólica de larga evolución. La tomografia helicoidal sin contraste (pielo TAC) muestró imagen hipodensa en fosa iliaca izquierda. Se realiza laparoscopia quirúrgica resecándose el tumor. La biopsia fue informada como muestra constituida por pared tipo corporal uterino. Caso 3: Paciente sometida a histerectomía total abdominal. Dos años después en ecotomografía vaginal de rutina se pesquisa tumor pelviano sólido de probable origen anexial izquierdo. La resonancia magnética sugiere leiomioma. La laparoscopía diagnóstica objetiva tumor sólido en relación a la cúpula vaginal compatible con mioma. Se reseca el tumor y el estudio anátomo patológico confirma el diagnóstico. Conclusión: La retención de fragmentos uterinos es una complicación infrecuente de la histerectomía supracervical laparoscópica que sería posible prevenir. La laparoscopía tiene un rol en la resolución de retención de fragmentos uterinos post histerectomía. La resonancia magnética aportó información relevante en estos casos.PALABRAS CLAVE: Miomatosis pélvica, histerectomía supracervical laparoscópica, morcelación uterina SUMMARYWe will present the cases of three patients in the fifth decade of their life, that had undergone an histerectomy with the diagnosis of uterine leiomyoma. Case 1: Pacient had undergone a supracevical laparocopic hysterectomy. The uterus had been extracted from the abdominal cavity by electrical morcellation. Four years after the procedure, she presents ciclic pelvic pain which requires hospitalization. The magnetic resonante suggests vascularized tumors in the pelvis. A diagnostic laparoscopy was done, removing miometrial and endometrial tissue. Case 2: Pacient had undergone a supracevical laparocopic hysterectomy twelve years ago with the diagnosis of leiomyoma. She requires medical attention because of a colic pain in the left ilac fossa. The unhenhanced helicoidal CT-Scan shows an hipodense image in the left iliac fossa. A REV CHIL OBSTET GINECOL 2010; 75(1): 42 -46

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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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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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Umbilical endometriosis after unprotected removal of uterine pieces through the umbilicus

Cited by 31 publications

References 33 publications

Primary umbilical endometriosis: To scope or not to scope?

Primary umbilical endometriosis: To scope or not to scope?

Hallazgo De Fragmentos Uterinos Intrabdominales Poshisterectomía

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

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