Endometriosis (adenomyoma) in postoperative scars: An analysis of thirty-one cases

Abstract

Thirty-one cases of endometriosis in postoperative scars were analyzed. It was found that in the majority of cases the lesion followed operations performed on the uterus or fallopian tubes, but that in the performance of most of these operations the lining of these organs had not been exposed. A few of the tumors seem to have originated from exposedp ortions of endometrium and to have invaded the abdominal wall secondarily, but others were definitely separated from the uterine lining. The etiology of this condition is unknown, but, in most cases, the best evidence points toward transplantation or invasion (migration) of endometrium from the lining of the uterus. The endometriomas in question resemble endometrium, histologically, and in one case an unabsorbed suture was presented, which may or may not represent the contaminating vehicle during the original operation. In a large number of cases in which the condition followed ventral suspension of the uterus, the round ligaments were involved with endometriosis, at those points at which they were sutured to the anterior abdominal wall. Pain, worse at the menstrual period, and the presence of a palpable nodule, were most commonly complained of by the patients. Few of the tumors discharged a bloody fluid at the menstrual period. In a few cases there were no symptoms. The diagnoses were made more often in the ten years prior to the time of this report, for the medical profession is now more aware of this entity than it had been formerly. The differential diagnosis most often includes, keloids, desmoids, fibromas, neuromas, incarcerated omental hernias and uterine or tubal fistulas. If the condition is uncomplicated, cure may be obtained by wide excision. One instance of recurrence was encountered; undoubtedly the condition in this case was caused by inadequate excision at the time of the first operation.