Taiwanese Journal of Obstetrics and Gynecology
Volume 47, Issue 1 , Pages 42-48, March 2008

Abdominal Wall Endometriosis: An Overlooked but Possibly Preventable Complication

  • Chen-Chih Teng

      Affiliations

    • Department of Obstetrics and Gynecology, Han-Ming Hospital, Changhua, Taiwan
    • ,
  • Han-Ming Yang

      Affiliations

    • Corresponding Author InformationCorrespondence to: Dr Han-Ming Yang, Han-Ming Hospital, 366, Section 1, Chung-Shan Road, Changhua 500, Taiwan
    • Department of Obstetrics and Gynecology, Han-Ming Hospital, Changhua, Taiwan
    • ,
  • Kuang-Fa Chen

      Affiliations

    • Department of Obstetrics and Gynecology, Han-Ming Hospital, Changhua, Taiwan
    • ,
  • Chi-Jui Yang

      Affiliations

    • Department of Obstetrics and Gynecology, Han-Ming Hospital, Changhua, Taiwan
    • ,
  • Lien-Sheng Chen

      Affiliations

    • Department of Obstetrics and Gynecology, Han-Ming Hospital, Changhua, Taiwan
    • ,
  • Chuen-Long Kuo

      Affiliations

    • Department of Pathology, Show-Chwan Memorial Hospital, Changhua, Taiwan

Accepted 30 October 2007.

Article Outline

Summary 

Objective

To find ways of preventing abdominal wall endometriosis through a retrospective case review.

Materials and Methods

A retrospective study of 22 patients presenting with 26 postoperative abdominal wall masses. All masses were pathologically proved to be scar endometriosis between September 1994 and September 2006. The age, parity, symptoms and duration, previous surgeries, interval between previous surgery and current operation, initial diagnosis, and the 26 sites and size of endometrioma were recorded and analyzed.

Results

About 60% of the patients were in the fourth decade of life. All 22 cases, except one with mid-trimester hysterotomy, had previous cesarean section (CS). Three cases had vertical midline incision for CS, and the other 19 had Pfannenstiel incision, 18 of which were for CS and one for hysterotomy. Of the 22 cases, only three had multiple endometriomas, i.e. one case had three foci and the other two cases had two foci each. Twenty-three endometriomas were found in the Pfannenstiel incision group; 19 out of the 23 foci (82%) were located in either corner of the Pfannenstiel incision wounds (with right side predominance in 13 out of 19). Three endometriomas were noted in vertical midline incisions and two were in the upper corner. Three endometrioma excisions were done during repeated CS.

Conclusion

Abdominal wall endometriosis may be caused by iatrogenic inoculation of the endometrium into the surgical wound. It is strongly recommended that, at the conclusion of the surgical procedure, the abdominal wound be cleaned thoroughly, particularly at both corner sites (especially the operator's side). If an abdominal wall endometriosis is encountered after CS but the patient plans to have future pregnancy and the symptoms are mild, excision of the endometrioma may be deferred until the next indicated CS.

Key Words:  abdominal wall endometrioma , abdominal wall endometriosis , cesarean section , hysterotomy , scar endometriosis

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Chatterjee SK . Scar endometriosis: a clinicopathologic study of 17 cases . Obstet Gynecol . 1980;56:81–84
  2. Wolf GC , Singh KB . Cesarean scar endometriosis: a review . Obstet Gynecol Surv . 1989;44:89–95
  3. Kaunitz A , Di Sant'Agnese PA . Needle tract endometriosis: an unusual complication of amniocentesis . Obstet Gynecol . 1979;54:753–755
  4. Hughes ML , Bartholomew D , Paluzzi M . Abdominal wall endometriosis after amniocentesis: a case report . J Reprod Med . 1997;42:597–599
  5. Healy JT , Wilkinson NW , Sawyer M . Abdominal wall endometrioma in a laparoscopic trocar tract: a case report . Am Surg . 1995;62:962–963
  6. Olufowobi O , Sorinola O , Miller SJ , Condie RG . Scar endometrioma: a cause for concern in the light of the rising caesarean section rate . J Obstet Gynaecol . 2003;23:86
  7. Wasfie T , Gomez E , Seon S , Zado B . Abdominal wall endometrioma after cesarean section: a preventable complication . Int Surg . 2002;87:175–177
  8. Bumpers HL , Butler KL , Best IM . Endometrioma of the abdominal wall . Am J Obstet Gynecol . 2002;187:1709–1710
  9. Taff CL , Jones MS . Cesarean scar endometriosis: a report of two cases . J Reprod Med . 2002;47:50–52
  10. Ding DC , Hsu S . Scar endometriosis at the site of cesarean section . Taiwanese J Obstet Gynecol . 2006;45:247–249
  11. Steck MW , Helwig EB . Cutaneous endometriosis . J Am Med Assoc . 1965;191:101–104
  12. Daye SS , Barone JE , Lincer RM , Blabey RC , Smego DR . Pfannenstiel syndrome . Am Surg . 1993;59:459–460
  13. Esquivel-Estrada V , Briones-Garduno JC , MondragonBallesteros R . Endometriosis implant in cesarean section surgical scar . Cir Cir . 2004;72:113–115 [In Spanish]
  14. Rao R , Devalia H , Zaidi A . Post-caesarean incisional hernia or scar endometrioma? . Surgeon . 2006;4:55–56
  15. Blanco RG , Parithivel VS , Shah AK , Gumbs MA , Schein M , Gerst PH . Abdominal wall endometriomas . Am J Surg . 2003;185:596–598
  16. Witz CA . Current concepts in the pathogenesis of endometriosis . Clin Obstet Gynecol . 1999;42:566–585
  17. Fujino K , Ueda M , Takehara M , et al.   Transcriptional expression of survivin and its splice variants in endometriosis . Mol Hum Reprod . 2006;12:383–388
  18. Ueda M , Yamashita Y , Takehara M , et al.   Survivin gene expression in endometriosis . J Clin Endocrinol Metab . 2002;87:3452–3459
  19. Tarkowski R , Kotarski J , Polak G , Wojcierowski J . Expression of the survivin gene in the scar endometriosis and in normal human endometrium . Ginekol Pol . 2001;72:1539–1542 [In Polish]
  20. Madsen H , Hansen P , Andersen OP . Endometrioid carcinoma in an operation scar . Acta Obstet Gynecol Scand . 1980;59:475–476
  21. Matter M , Schneider N , McKee T . Cystadenocarcinoma of the abdominal wall following caesarean section: case report and review of the literature . Gynecol Oncol . 2003;91:438–443
  22. Prentice A . Endometriosis . BMJ . 2001;323:93–95
  23. Francica G , Giardiello C , Angelone G , Cristiano S , Finelli R , Tramontano G . Abdominal wall endometriomas near cesarean delivery scars: sonographic and color Doppler findings in a series of 12 patients . J Ultrasound Med . 2003;22:1041–1047
  24. Amato M , Levitt R . Abdominal wall endometrioma: CT findings . J Comput Assist Tomogr . 1984;8:1213–1214
  25. Gupta RK , Naran S . Aspiration cytodiagnosis of endometriosis in an abdominal scar after cesarean section . Acta Cytol . 1995;39:603–604
  26. Gaunt A , Heard G , McKain ES , Stephenson BM . Caesarean scar endometrioma . Lancet . 2004;364:368
  27. Wang PH , Juang CM , Chao HT , Yu KJ , Yuan CC , Ng HT . Wound endometriosis: risk factor evaluation and treatment . J Chin Med Assoc . 2003;66:113–119

PII: S1028-4559(08)60053-4

doi:10.1016/S1028-4559(08)60053-4

Taiwanese Journal of Obstetrics and Gynecology
Volume 47, Issue 1 , Pages 42-48, March 2008

Article Tools