scholarly journals Abdominal Wall Endometriosis: Two Case Reports and Literature Review

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 727
Author(s):  
Bogdan Doroftei ◽  
Theodora Armeanu ◽  
Radu Maftei ◽  
Ovidiu-Dumitru Ilie ◽  
Ana-Maria Dabuleanu ◽  
...  

Background and objectives: Abdominal wall endometriosis, also known as scar endometriosis, is a rare condition that is becoming increasingly common. The recent rise in incidence is attributed primarily to the surge of cesarean births, figures that could be influenced in a positive manner considering the improvements brought towards the ultrasound diagnostic methods that have been made in recent years. Materials and Methods: Here we report the cases of two Caucasian women of 38- (G2P2) and 36-years old (G1P1), both subjected to an ultrasound examination due to a specific symptomatic panel reported during anamnesis. Independently of the current status, in the first patient, there were no reported symptom-specific associations with endometriosis, but she had a known history of mild hereditary thrombophilia; the second woman suffered from two conditions positively associated with endometriosis. Results: In both cases, abnormal structures were revealed, with the diagnostic(s) of endometriosis being histologically confirmed based on a set of features observed during the investigation. Conclusions: This paper aims to highlight the importance of reducing cesarean births and to consider the diagnosis of scar endometriosis in women with a history of obstetric or gynaecological surgeries who present with cyclic, recurrent abdominal pain.

2016 ◽  
Vol 29 (1) ◽  
pp. 3-8
Author(s):  
Quorrata Eynul Forhad ◽  
Ali Akbar Biswas ◽  
Sk Monirul Islam ◽  
Md Shah Alam

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


2013 ◽  
Vol 98 (2) ◽  
pp. 145-148 ◽  
Author(s):  
Takahito Kitajima ◽  
Mikihiro Inoue ◽  
Keiichi Uchida ◽  
Kohei Otake ◽  
Masato Kusunoki

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.


2021 ◽  
Vol 11 (3) ◽  
pp. 1004-1012
Author(s):  
Xiuchun Zhang

Abdominal wall endometriosis is a common endometriosis, which is located outside the endometrium, such as the myometrium or subcutaneous fat layer of the abdominal wall, forming a mass, active and infiltrating into the surrounding tissue, accompanied by menstrual pain, and seriously affecting the quality of life of patients. With the increasing operation of caesarean section and other traumatic operations, the incidence rate of abdominal wall endometriosis is increasing. Because of the variety of clinical manifestations of abdominal wall endometriosis, there are many kinds of diagnostic methods. Choosing the appropriate diagnostic methods to confirm abdominal wall endometriosis has become the primary work of diagnosis and treatment of abdominal wall endometriosis. This paper discusses the clinical value of high frequency colour doppler ultrasound in the diagnosis of abdominal wall endometriosis. Compared with the diagnosis of ordinary ultrasound and high frequency colour doppler ultrasound, the location, shape, size, boundary, internal echo, blood flow velocity, blood flow resistance and other parameters of the mass in the focus were observed. It is proved that the application of high-frequency colour doppler ultrasound can greatly improve the ultrasonic diagnosis rate of abdominal wall endometriosis, and it is non-invasive, radiation-free, low price, easy for patients to accept. It provides a high value clinical diagnosis basis for the early detection and treatment of abdominal wall endometriosis.


2021 ◽  
Vol 37 (1) ◽  
pp. 68-72
Author(s):  
Sefa Ergün ◽  
Kazım Koray Öner

Objective: Endometriosis is defined as the presence of normal endometrial mucosa abnormally implanted in locations other than the uterine cavity. It is most commonly located in the pelvis but it is also rarely observed in the gastrointestinal tract, lung, liver, kidneys, central nervous system and abdominal wall. Abdominal wall endometriosis (AWE) commonly occurs following a caesarean section or pelvic surgery. The patients consult the physician mostly with complaints of cyclic abdominal pain and a palpable mass in the abdomen. The basic methods in diagnosing AWE are anamnesis and physical examination but ultrasound, computerized tomography, and sometimes magnetic resonance imaging of the abdomen are also used. Material and Methods: In our study, we retrospectively analyzed 9 patients who underwent surgery at Avcılar State Hospital General Surgery Service between January 2015 and December 2018 with a preliminary diagnosis of AWE and confirmation through pathology results. Results: Median age of the patients was 32 ± 4.66 and median body mass index (BMI) was 24.6 ± 1.15. Every patient except 1 had a history of cesarean section history. One patient was operated because of recurrence. Patients consulted the hospital with complaints of pain during menstruation and abdominal swelling. The start of the complaints was 4.1 years following C-section. Mostly ultrasound was used for imaging. For treatment, they all received en-bloc mass excision and their pathological diagnosis were compliant with endometriosis. Average surgery time was 40 minutes and average endometriosis lesion dimension was 3.4 cm. It was observed that the lesion extended to the anterior abdominal fascia in 6 of the patients, and 2 patients underwent fascia repair with propylene mesh because of the excessive defect size. No postoperative complication occured in any patient and no recurrence is observed. Conclusion: In patients with periodic abdominal pain and swelling on the abdominal wall, AWE could be suspected and early diagnosis can be realized by carefully taking medical history and following physical examination, and appropriate radiological examinations and necessary surgical intervention can be performed. The method of diagnosis and treatment is to remove the lesion through wide excision.


2021 ◽  
Author(s):  
Vishal Bahall ◽  
Lance De Barry ◽  
Arlene Rampersad

Abstract Background: Malignant transformation of abdominal wall endometriosis is extremely rare. Clear cell carcinoma and endometrioid carcinoma are the two most prevalent histological subtypes of malignant endometriosis. To date, approximately thirty cases of clear cell carcinoma arising from abdominal wall endometriosis have been described worldwide.Case Presentation: We report two cases of clear cell carcinoma developing postoperatively in the anterior abdominal wall in women with a history of extensive endometriosis. Histopathology of the resected abdominal wall tumor demonstrated benign endometriosis contiguous with features of clear cell carcinoma. These histological features satisfied Sampson’s criteria which are required for diagnosing malignant endometriosis. Both patients were successfully managed with platinum-based adjuvant chemotherapy following cytoreductive surgery. Conclusion: Clear cell carcinoma arising from abdominal wall endometriosis is a rare, highly aggressive cancer with a propensity to recur or metastasize. Due to the limited publications on this clinical entity, there are no clearly established protocols regarding adjuvant treatment, and an evaluation of prognostic factors is lacking. Clinicians must have a high index of suspicion for malignant endometriosis of the abdominal wall, particularly in patients with an abdominal wall mass, prior abdominal surgery, and long-standing endometriosis. By presenting our case, we expect to raise awareness and study of this rare endometriosis-related neoplasm.


2021 ◽  
Vol 14 (5) ◽  
pp. e239923
Author(s):  
Nisa Utami Ika Permatasari ◽  
Fadlan Fediansyah Hutabarat ◽  
Henny Meitri Andrie Rachmasari Putri

Scar endometriosis is a rare condition highly related to history of abdominal surgery. Due to the low incidence, it is often misdiagnosed. A woman presented to the surgery outpatient clinic with a mass near her C-section scar. Physical examination and ultrasound suggested Incisional Hernia while intraoperative finding revealed a mass suggestive of endometriosis which later confirmed by pathology examination. Scar endometriosis is a common subtype of extra-pelvic endometriosis. Iatrogenic transplantation is speculated to be its etiopathogenesis. Preoperatively, it is challenging to differentiate endometriosis from another abdominal masses. The definitive diagnosis is based on laparoscopy or surgery with histological verification. Chronic pain is complex and often involves multiple factors beyond simply a diagnosis of endometriosis, but it is important to think of endometriosis on women patients presenting with a mass and cyclic pain with history of surgery involving a large amount of endometrial cell.


2012 ◽  
Vol 97 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Arif Emre ◽  
Sami Akbulut ◽  
Mehmet Yilmaz ◽  
Zehra Bozdag

Abstract 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.


2018 ◽  
Vol 71 (suppl. 1) ◽  
pp. 83-86
Author(s):  
Goran Malenkovic ◽  
Sanja Tomic ◽  
Bratislav Stoiljkovic

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.


2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
S. De Schrijver ◽  
I. Theate ◽  
O. Vanhooteghem

Background. Halo nevi are often considered benign, and the possibility of malignancy is not always clear to practitioners. We present two case reports suggesting that a halo nevus appearance can be seen in melanoma, even in young adults. A literature search for halo nevi revealing melanoma shows that this is a very rare condition. Case presentation. This report of two young patients indicates the importance of obtaining a detailed history to detect warning signs such as itching, pain, spontaneous bleeding, and previous alterations according to the patient, including a previously totally black colour in an already fully regressed melanoma. Conclusions. The risk of a halo nevus being malignant is higher if there is only one unique halo nevus and no personal or familial history of vitiligo. We postulate that a regressing atypical nevus or a regressing melanoma may be induced by an immunologic reaction as halo nevus type of clinical picture.


2017 ◽  
Vol 90 (4) ◽  
pp. 411-415 ◽  
Author(s):  
Andrei Mihai Malutan ◽  
Ioan Simon ◽  
Razvan Ciortea ◽  
Radu Florin Mocan-Hognogi ◽  
Marina Dudea ◽  
...  

Background and aims. Endometriosis is a commonly found disorder in women of reproductive age, consisting in the presence of active ectopic endometrial tissue outside of the endometrial cavity. Surgical scar endometriosis is a rare condition representing about 2% of all endometriosis cases. The purpose of this study was to assess the main characteristics, diagnosis tools and therapeutic options in abdominal wall endometriosis (AWE). Methods. We have reviewed a series of fourteen cases with histopathological confirmation of AWE that were managed in our institution.Results. The main characteristic of AWE were emphasiszed, showing that 78.57% of the patients had at least one previous caesarian section and that in only 57.14% out of ol case an accurate diagnosis of AWE was established preoperatively. Conclusion. A direct relationship between gynecological and obstetrical surgery and AWE is well established and as the caesarian section rates increase constantly, the awareness regarding AWE should also be increased.


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