scholarly journals The ultrasound of subcutaneous extrapelvic endometriosis

2020 ◽  
Vol 20 (82) ◽  
pp. 176-180
Author(s):  
Ashraf Talaat Youssef ◽  
Keyword(s):  
Cesarean Section ◽  
Abdominal Wall ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Final Diagnosis ◽  
Clinical Findings ◽  
Ca 125 ◽  
Diagnostic Significance ◽  
Ovarian Endometriosis ◽  
Extrapelvic Endometriosis

Background: The presence of ectopic functional endometrial glands and struma anywhere except in the lining of the uterine cavity is considered as endometriosis. Extrapelvic endometriosis involving the abdominal wall cesarean section scar is uncommonly seen, and it rarely involves the perineum, umbilicus, pleura, kidneys, lungs and liver. Objectives: The purpose of the present study is to highlight rare ectopic sites, explain the pathogenesis of extrapelvic endometriosis, and evaluate the diagnostic significance of clinical findings, serum CA 125 level, and ultrasonography. Materials and methods: 24 female patients with extrapelvic endometriomas in whom the final diagnosis was based on the surgical results and histopathological reports of the excised specimens. The patients underwent a clinical examination, an ultrasound scan, and evaluation of the serum CA 125 level. They were also examined by transvaginal ultrasound to rule out ovarian endometriosis or uterine adenomyosis. They were further subjected to abdominal wall ultrasound in cases of cesarean section scar or umbilical region swellings, and transperineal ultrasound for perianal lesions. Transvaginal ultrasound was performed in patients with perineal endometrioma to assess the relation between the lesion and the external anal sphincter. Results: In 19 patients, abdominal wall cesarean section scar endometrioma was detected. Three patients had perianal endometriomas, and two patients – umbilical endometriomas. Conclusion: Ultrasound scanning was a useful diagnostic tool to evaluate extrapelvic endometriosis and its extension, especially in cases without typical clinical features that can be suggestive of endometrioma, low diagnostic sensitivity of serum CA 125, and low incidence of concomitant intrapelvic disease.

scholarly journals Abdominal Wall Endometriosis: Clinical Presentation And Imaging Features with Emphasis on Sonography

2016 ◽  
Vol 29 (1) ◽  
pp. 3-8
Author(s):  
Quorrata Eynul Forhad ◽  
Ali Akbar Biswas ◽  
Sk Monirul Islam ◽  
Md Shah Alam
Keyword(s):  
Cesarean Section ◽  
Abdominal Wall ◽  
Power Doppler ◽  
Clinical Findings ◽  
Imaging Features ◽  
Palpable Mass ◽  
Scar Endometriosis ◽  
Abdominal Wall Endometriosis ◽  
Cystic Changes ◽  
Pathological Material

Objective(s): The purpose of our study was to evaluate clinical findings and sonographic features of abdominal wall endometriosis and also to report its CT and MRI appearance.Materials and methods: A retrospective study was performed from January 2008 - December 2012, yielding 12 surgically proven cases of abdominal wall endometriosis. All patients had undergone sonography including power Doppler examination. Additional CT was performed in one case and MRI in four. Pathological material was preoperatively obtained by sonographically guided puncture in six patients. The clinical data were analyzed and the imaging studies were reviewed by radiologist working in consensus.Results: All patients had a history of at least one prior cesarean section. All patients’ C/S was done in this institution and 1500 C/S were performed within a period of 5 years giving a frequency of 0.8% scar endometriosis after C/S. All presented with focal pain near the surgical scar, which was cyclic in three patients. Nine patients presented with a palpable mass near the scar. Sonography detected 11 lesions within the abdominal wall with a mean diameter 25mm and in one case sonography could not identify any lesion. All lesions were hypoechoic, vascular, and solid, with some cystic changes in one. MRI CT scan showed enhancement of the lesions. Finally histopathologically all were proved as endometriosis’.Conclusion: Abdominal wall endometriosis frequently presents with noncyclic symptoms. Imaging findings of a solid mass near a cesarean section scar strongly suggest its diagnosis.Bangladesh J Obstet Gynaecol, 2014; Vol. 29(1) : 3-8

Can be Considered the CA-125 and Neutrophil-to-lymphocyte Ratio Values as a Diagnostic Value in Ovarian Endometriosis?

2019 ◽  
Vol 69 (12) ◽  
pp. 3561-3564
Author(s):  
Catalin Dumitru ◽  
Narcisa Carmen Mladin ◽  
Marius Craina ◽  
Izabella Petre ◽  
Lavinia Cristina Moleriu ◽  
...  
Keyword(s):  
Transvaginal Ultrasound ◽  
Surgical Excision ◽  
Diagnostic Value ◽  
Neutrophil To Lymphocyte Ratio ◽  
Ca 125 ◽  
Ovarian Endometriosis ◽  
Delay In Diagnosis ◽  
Lymphocyte Ratio ◽  
Correlation And Regression Analysis ◽  
Medical Tests

In Romania it is estimated that there are half a million patients with endometriosis. The main symptoms are pain (70% of patients with chronic pelvic pain have endometriosis) and infertility (50% of infertile patients have endometriosis). It is difficult to make an accurate diagnosis. Numerous studies show a 7-10-year delay in diagnosis in women in developing countries. 47% of patients should be seen by more than 5 physicians over time until the diagnosis is established. The treatment for endometriosis is the surgical procedure and it is most often performed laparoscopically. The present study was carried in the Obstetrics and Gynecology Departments of the Pius Brinzeu Emergency Clinical Hospital Timisoara. We have included in this study patients who were hospitalized between 2013 and 2017. We have 142 patients who qualified for this study. All the patients had made the same medical tests: we collected information about their age, the neutrophil, lymphocyte and CA125 values, the position of the cyst and the cyst dimension. The aim of this study is to find if there is any association between the CA-125 markers (coelomic epithelial antigen) and the neutrophil-to-lymphocyte ratio in patients who were diagnosed with ovarian endometriosis by transvaginal ultrasound. In all cases the patients underwent laparoscopic surgery. After performing a correlation and regression analysis we obtained that we have a positive strong significant association between the CA 125 values and the ratio values (r=0.94; R2=0.88; p[0.001) . After the surgical excision of endometriosis, CA-125 can be used to monitor the evolution of endometriosis outbreaks, especially when there is a recurring severe pain.

scholarly journals Cеsarean section scar endometrosis

2018 ◽  
Vol 71 (suppl. 1) ◽  
pp. 83-86
Author(s):  
Goran Malenkovic ◽  
Sanja Tomic ◽  
Bratislav Stoiljkovic
Keyword(s):  
Cesarean Section ◽  
Abdominal Wall ◽  
Metastatic Cancer ◽  
Surgical Techniques ◽  
Uterine Cavity ◽  
Endometrial Tissue ◽  
Abdominal Wall Endometriosis ◽  
Primary Surgery ◽  
History Of ◽  
Subcutaneous Tissues

Endometriosis is defined as a functional endometrial tissue outside the uterine cavity. The ectopic endometrial tissue has been identified after gynecologic laparoscopy or laparotomy procedures in the skin, subcutaneous tissues, abdominal and pelvic wall musculature, and it represents amayor cause of acute or chronic recurrent abdominal or pelvic pain resembling the menstrual cycle. The frequency of abdominal wall endometriosis is approximately 1% of all women who had a cesarean delivery. A 39-year-old patient with a history of one prior Cesarean section, presented with continuous cyclical focal pain at the left part of cesarean scar site for the past 16 months, 23 months after Cesarean section. The patient underwent a mini laparotomy, when endometrioma was completely removed surgically. The PH diagnosis of endometriosis was based on the presence of all elements of the endometrial mucosa (glands, stroma and signs of fresh and old hemorrhage) in an inadequate place (anterior abdominal wall). Endometriosis is difficult to diagnose and it is often mistaken for other conditions such as a suture granuloma, incisional hernia, primary or metastatic cancer. Endometriosis can be prevented only with good surgical techniques and clinical practice as well as the proper care during primary surgery.

scholarly journals Endometriosis in cesarean section surgical scar

2007 ◽  
Vol 54 (2) ◽  
pp. 79-81 ◽  
Author(s):  
D. Stefanovic ◽  
M. Kerkez ◽  
Z. Djordjevic ◽  
S. Knezevic ◽  
Lj. Markovic ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Abdominal Wall ◽  
Uterine Cavity ◽  
Surgical Excision ◽  
Histopathologic Examination ◽  
Surgical Scar ◽  
Decidual Tissue ◽  
History Of ◽  
One Year

Introduction: Endometriosis is the presence of endometrial glands and stroma outside of uterine cavity. It may occur in the abdominal wall scar after the operation in which uterus was opened. In cesarean section scar it occurs in 0.4%. It is in 2/3 patients characterized with triad of: tumor, periodic pain associated with menses and history of cesarean section. The mechanism of endometriosis occurring in the cesarean scar is felt to be secondary to iatrogenic transplantation of endometrium or extrauterine decidual tissue into the incision during the cesarean section. Case outline. Forty years old patient with tumor 4,5x4 cm that appeared in abdominal wall scar one year after second cesarean section, followed by periodic pain and macroscopic changes associated with menses. First diagnosis was granuloma in the surgical scar, but as she had periodic symptoms, diferential diagnosis was endometriosis. Hormonal therapy with contraceptive drugs was ordered. As it was no improvement she was operated. The surgical excision of the tumor including fascia and muscle tissue was done. Sample revealed endometrium after histopathologic examination. Patient was completely recovered and without relapse of symptoms during follow up to date. Conclusion. When there is a tumor in the cesarean section scar or scar after the operation in which uterus or ovarial tube was opened, followed with periodical pain and macroscopic changes associated with menses, endometriosis should be considered. Surgical excision of the tumor is sufficient and patohistological examination confirms diagnosis. .

scholarly journals HE4 might be a more useful tumor biomarker to detect malignancy in patients with ovarian endometrioma when malignancy is suspected

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110477
Author(s):  
Mariona Rius ◽  
Pere Fusté ◽  
Cristina Ros ◽  
Ángeles Martínez-Zamora ◽  
Cristian deGuirior ◽  
...  
Keyword(s):  
Ovarian Carcinoma ◽  
Final Diagnosis ◽  
Carbohydrate Antigen ◽  
Transvaginal Ultrasonography ◽  
Ca 125 ◽  
Blood Levels ◽  
Tumor Biomarker ◽  
Ovarian Endometriosis ◽  
Adnexal Masses ◽  
Group 3

Objective To analyze the utility of carbohydrate antigen (CA)125 and human epididymis protein 4 (HE4) to detect malignancy in women with ovarian endometriosis, when ovarian cancer is suspected and ultrasonography results are inconclusive. Methods Women who underwent surgery between 2015 and 2019 for ovarian endometriosis or for adnexal masses, with a final diagnosis of ovarian carcinoma (clear cell and endometrioid) were included in this retrospective study. The women were divided into three groups: ovarian endometriosis (OE), ovarian carcinoma without endometriosis (OC), and ovarian carcinoma with endometriosis (OC + E). Adnexal masses were assessed preoperatively by transvaginal ultrasonography according to the International Ovarian Tumor Analysis (IOTA) simple rules, and CA125 and HE4 blood levels were obtained. Results Of 208 women, 45 had malignancy, 16 in the OC + E group and 29 in the OC group. According to transvaginal ultrasonography, 13 were classified as undetermined risk of malignancy: OC group: 3, OE group: 3, and OC + E group: 7. When we compared the tumor biomarkers, significant differences in HE4 but not in CA125 levels were found between the groups. Conclusions When ovarian malignancy is suspected in patients with ovarian endometriosis, HE4 is a more useful tumor biomarker to diagnose OC when ultrasonography results are inconclusive.

scholarly journals A Case of Placenta Increta Mimicking Submucous Leiomyoma

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Ali Ekiz ◽  
Ibrahim Polat ◽  
Sezcan Mumusoglu ◽  
Burchan Aydiner ◽  
Cagdas Ozdemir ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Postpartum Hemorrhage ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Uterine Cavity ◽  
Final Diagnosis ◽  
Curative Treatment ◽  
Pathological Examination ◽  
Placenta Increta ◽  
Early Postpartum

In recent years with the increase in cesarean section rates, the frequency of placenta accreta cases rises. It causes 33–50% of all emergency peripartum hysterectomies. We present a 42-year-old case who was caught with early postpartum hemorrhage due to retained placental products. The ultrasonography showed a 65 × 84 mm mass in the uterine cavity after the delivery. Due to presence of early postpartum hemorrhage which needs transfusion, an intervention decision was made. The patient underwent curettage but the mass could not be removed so that placental retention was ruled out. Submucous leiomyoma was made as first-prediagnosis. Hysterectomy operation was performed as a curative treatment. Placenta increta diagnosis was made as a final diagnosis with pathological examination. As a result, placental attachment disorders may be overlooked if it is not a placenta previa case.

scholarly journals Isthmocele: an overview of diagnosis and treatment

2019 ◽  
Vol 65 (5) ◽  
pp. 714-721 ◽  
Author(s):  
Thaysa Guglieri Kremer ◽  
Isadora Bueloni Ghiorzi ◽  
Raquel Papandreus Dibi
Keyword(s):  
Cesarean Section ◽  
Surgical Management ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Cost Effective ◽  
Uterine Wall ◽  
Large Defect ◽  
Cesarean Scar ◽  
Incomplete Closure ◽  
Previous Cesarean

SUMMARY An isthmocele, a cesarean scar defect or uterine niche, is any indentation representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity, at the site of a previous cesarean section scar. It can be classified as a small or large defect, depending on the wall thickness of the myometrial deficiency. Although usually asymptomatic, its primary symptom is abnormal or postmenstrual bleeding, and chronic pelvic pain may also occur. Infertility, placenta accrete or praevia, scar dehiscence, uterine rupture, and cesarean scar ectopic pregnancy may also appear as complications of this condition. The risk factors of isthmocele proven to date include retroflexed uterus and multiple cesarean sections. Nevertheless, factors such as a lower position of cesarean section, incomplete closure of the hysterotomy, early adhesions of the uterine wall and a genetic predisposition may also contribute to the development of a niche. As there are no definitive criteria for diagnosing an isthmocele, several imaging methods can be used to assess the integrity of the uterine wall and thus diagnose an isthmocele. However, transvaginal ultrasound and saline infusion sonohysterography emerge as specific, sensitive and cost-effective methods to diagnose isthmocele. The treatment includes clinical or surgical management, depending on the size of the defect, the presence of symptoms, the presence of secondary infertility and plans of childbearing. Surgical management includes minimally invasive approaches with sparing techniques such as hysteroscopic, laparoscopic or transvaginal procedures according to the defect size.

scholarly journals Abdominal wall endometriosis: clinical presentation, imaging features and management of five cases

2020 ◽  
Vol 148 (7-8) ◽  
pp. 484-488
Author(s):  
Goran Malenkovic ◽  
Sanja Tomic ◽  
Jasmina Boban ◽  
Nensi Lalic ◽  
Marko Bojovic
Keyword(s):  
Cesarean Section ◽  
Abdominal Wall ◽  
Surgical Techniques ◽  
Case Series ◽  
Uterine Cavity ◽  
Good Clinical Practice ◽  
Definitive Treatment ◽  
Imaging Features ◽  
Abdominal Wall Endometriosis ◽  
Uncommon Condition

Introduction. Endometriosis represents a functional endometrium outside the uterine cavity. Ectopic endometrial tissue has been identified within the pelvis, affecting both pelvic and extrapelvic organs, causing recurrent pelvic or abdominal pain corresponding to the menstrual cycle. The incidence of abdominal wall endometriosis after Cesarean section is approximately 2%. It is often mistaken for other conditions primarily because this condition is underestimated on imaging. The objective of this case series is to summarize possible clinical and radiological presentations of this uncommon condition. Outline of cases. The authors present a case series of five patients who developed abdominal wall endometriosis after Cesarean section. Having been diagnosed clinically, the patients underwent open abdominal surgery, and were treated by surgical resection. Conclusion. Good clinical practice and excellent surgical techniques may help in preventing endometriosis, while adequate clinical examination and proper imaging can help in presurgical planning and successful definitive treatment.

scholarly journals Uterine Healing after Therapeutic Intrauterine Administration of TachoSil (Hemostatic Fleece) in Cesarean Section with Postpartum Hemorrhage Caused by Placenta Previa

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Katrine Fuglsang ◽  
Margit Dueholm ◽  
Estrid Stæhr-Hansen ◽  
Lone Kjeld Petersen
Keyword(s):  
Cesarean Section ◽  
Postpartum Haemorrhage ◽  
Placenta Previa ◽  
Post Partum ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Intrauterine Adhesions ◽  
Traditional Treatment ◽  
Reproductive Capability ◽  
Scar Healing

Background. Application of hemostatic fleece (TachoSil) directly onto the bleeding surfaces of the lower uterine segment has been used to obtain hemostasis during cesarean section caused by placenta previa.Methods. Eleven of 15 patients treated with TachoSil for excessive postpartum haemorrhage due to placenta previa were enrolled. An evaluation of the cesarean section scar by transvaginal ultrasound, the uterine cavity and endometrium by hysteroscopy, and the endometrium by biopsy were made. The main outcome measures were intrauterine adhesions, recovery of endometrium at the site of TachoSil application, visible remnants of TachoSil, and scar healing.Results. Eight patients had small remnants of TachoSil in the uterine cavity together with signs of resorption. All had a normal endometrial mucosa, and none had adhesions in the uterine cavity. All cesarean section scars were healed without defects.Conclusion. TachoSil did not seem to impair healing of the endometrium or scar formation in the uterus after intrauterine application. Resorption of TachoSil seems to progress individually. Intrauterine treatment with TachoSil is a valuable supplement to the traditional treatment of post partum haemorrhage and may help retain reproductive capability. This is a small study, and it will require more studies to confirm the reproducibility.

scholarly journals Retrospective clinicopathological analysis of scar endometriosis and its surgical management

2021 ◽  
Vol 10 (2) ◽  
pp. 658
Author(s):  
Kavitha Yogini Duraisamy ◽  
Devi Balasubramaniam ◽  
Karthikha Ravi ◽  
Aravinth Subramaniam
Keyword(s):  
Abdominal Wall ◽  
Diagnostic Laparoscopy ◽  
Clinical Presentation ◽  
Abdominal Mass ◽  
Clinical Findings ◽  
Pelvic Endometriosis ◽  
Scar Endometriosis ◽  
History Of ◽  
Extrapelvic Endometriosis ◽  
High Index Of Suspicion

Background: Scar endometriosis is a rare form of extrapelvic endometriosis. It is defined as presence of endometrial glands and stroma in the abdominal wall. They have a variable clinical presentation and present to various doctors. Abdominal mass along with cyclical pain is pathognomic of scar endometriosis. Objective was to analyse the clinical presentation and surgical outcomes of scar endometriosis.Methods: It was a retrospective observational study. We have collected records of 28 patients of scar endometriosis managed at GEM Hospital over a period of 3 years. Patients demographic features, previous surgery, clinical findings, surgical findings, association with pelvic endometriosis as noted on diagnostic laparoscopy, need for mesh,  recurrence rate on follow up were noted.Results: Mean age of patients was 32.1 years. History of previous caesarean surgery/hysterotomy was present in all patients. Major clinical presentation was cyclical pain. MRI or USG was done and abdominal wall lesions were demonstrated in all cases. Diagnostic laparoscopy was done in 26 of these patients and showed associated endometriosis in 9 patients. Plane of endometriosis was found to be subcutaneous for 9 cases, sheath in 7 and muscular in 12 cases. HPE was proven in all cases.Conclusions: Scar endometriosis is rare. High index of suspicion is needed for diagnosis, especially in cases of previous caesarean sections. MRI and USG are useful tools for diagnosis. Complete wide local excision of scar endometriosis is the primary modality of treatment. Diagnostic laparoscopy along with the procedure is helpful in diagnosing associated pelvic endometriosis.

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