Postoperative scar endometriosis of the anterior abdominal wall

Abstract

Introduction: Postoperative scar endometriosis (PSE) is a rare pathology caused by gynecological-obstetrical surgery. The aim of the study was to assess PSE of the anterior abdominal wall. Material and methods: The research included 26 consecutive cases of the anterior abdominal wall PSE surgically treated during 1991-2015. Results: The mean age of the patients with PSE was 31.1±1.1 (95% CI:28.85-33.30) years. PSE developed after 45.8±3.2 (95% CI:39.27-52.34) months. PSE developed after caesarian section (88.4%, n=23), laparoscopic surgery (7.6%, n=2) and myomectomy (3.8%, n=1). A mass was found in the postoperative scar (n=28). Pfannenstiel incision (n=23), inferior median (n=2), umbilical (n=1). Monofocal vs bifocal PSE (92% vs. 8%, p<0.0001). PSE in the left corner of the postoperative scar in 76.9% (n=20). Cyclic pain was the main symptom (57.6%, n=15). The diagnostic workout included: ultrasonography with Doppler (n=9), CT and MRI (n=10). PSE was localized in the abdominal wall layers as follows: subcutaneous vs. fascia and muscles vs. rectus abdominis muscle vs. umbilicus (30.7% vs. 53.8% vs. 11.5% vs.3.8%, p<0.0001). All the patients underwent enbloc surgical excision of the PSE. The aponeurosis defect was closed by: aponeurosis suture in 23/26 (88.4%) patients, abdominal alloplasty with synthetic meshes (n=3). Diagnosis was confirmed histopathologically and immunohistochemically (CD10, PR, ERα, CK7). Conclusion: Imaging methods (ultrasonography with Doppler, CT and MRI) have an important role in establishing the diagnosis of PSE and surgical tactics. Definitive diagnosis is confirmed histopathologically and immunohistochemically.