The clinical characteristics and surgical approach of scar endometriosis: A case series of 14 women.

Faik Tatli,Huseyin Cahit Yalcın,Osman Bardakci,Abdullah Ozgonul,Orhan Gozeneli,Ali Uzunkoy,Muhammet Emin Guldur,Adnan Incebiyik,Hacer Uyanikoglu

doi:10.17305/bjbms.2018.2659

Faik Tatli, Huseyin Cahit Yalcın + Show 7 more

Open Access

https://doi.org/10.17305/bjbms.2018.2659

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Abstract

Scar endometriosis, also referred to as abdominal wall endometriosis (AWE), is a rare form of endometriosis that usually develops in the scar after obstetric or gynecological surgeries, including cesarean section (CS). Recently, the occurrence of scar endometriosis has been increasing together with the increase of CS incidence. Scar endometriosis can be clinically misdiagnosed as hernia, lipoma, or hematoma. Here we retrospectively analyzed the clinical aspects of scar endometriosis and surgical approach in 14 patients from a tertiary hospital, who were treated by surgery, between 2012 and 2017. The mean age was 32.71 ± 8.61 years (range: 19-45). Palpable mass and cyclic pain at the scar site were the most common complaints. Twelve patients had previously undergone CS, and two patients had undergone a surgery of ovarian endometrioma. The preoperative diagnosis was determined with ultrasonography (US), magnetic resonance imaging (MRI), or computed tomography (CT). Preoperatively, scar endometriosis was diagnosed in 12/14 patients (85.7%), while 2 patients (14.3%) were diagnosed with inguinal hernia. The treatment was surgical excision in all patients; in addition, mesh repair surgery was performed in 1 patient with recurrent scar endometriosis. Postoperatively, endometriosis was confirmed by histology in all patients. The average size of endometriomas was 24.71 ± 6.67 mm (range: 11-35). No woman had concurrent pelvic endometriosis. In the follow-up period (mean: 9 months) the recurrence of endometriosis was not observed. Scar endometriosis should be considered in all women of reproductive age presenting with cyclic pain and swelling in their abdominal incision sites.

Highlights

Endometriosis is defined as the presence of endometrial glands and stroma outside of the uterine cavity [1]
We retrospectively analyzed the clinical aspects of scar endometriosis and surgical approach in 14 patients from a tertiary hospital
abdominal wall endometriosis (AWE) that occurs at the incision site is a very rare condition, and a few reports are available in the literature

Summary

INTRODUCTION

Endometriosis is defined as the presence of endometrial glands and stroma outside of the uterine cavity [1]. Depending on the area where it develops, endometriosis is characterized as endopelvic or extrapelvic. Endometriosis may occur in extrapelvic structures, including abdominal wall, urinary and gastrointestinal tract, skin, brain, and lungs [3,4]. Abdominal wall endometriosis (AWE) that develops at the site of the surgical incision after obstetric or gynecological surgeries, including cesarean section (CS), is called scar or incisional endometriosis [5]. The incidence of AWE after CS is 0.03–1% of women that underwent obstetric or gynecological surgeries. Because patients with scar endometriosis generally have complaints of cyclic pain and swelling at their incision site, surgery is often required for both the treatment and definitive diagnosis [7,8]. Faik Tatli, et al: Abdominal wall endometriosis in the surgical scars metaplasia in the surrounding tissue. We retrospectively analyzed the clinical aspects of scar endometriosis and surgical approach in 14 patients from a tertiary hospital

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