Öz
Amaç: Bu çalışmanın amacı, abdominal duvar endometriozisi (ADE) olan hastalarda demografik ve klinik özellikleri, tanı araçlarını, cerrahi seçenekleri ve nüks oranlarını değerlendirmektir.
Gereç ve Yöntemler: Ocak 2015 ile Ocak 2020 tarihleri arasından kliniğimizde ADE nedeniyle opere edilen 44 hasta çalışmaya dahil edildi. Hastalara ait demografik veriler, operasyon geçmişi, klinik özellikler, tanı için kullanılan görüntüleme yöntemi, uygulanan operasyon tipi ve rekürrens durumu değerlendirildi.
Bulgular: Çalışmaya dahil edilen hastaların, yaşlarının median değeri 35 (26-48) olarak belirlendi. Hastalardan 1 (%2,3)’inin abdominal operasyon öyküsü bulunmazken; 39 (%88,6) hastanın cesarean section (C/S), 2 (%4,5) hastanın myomektomi ve 2 (%4,5) hastanın da histerektomi öyküsü bulunmaktadır. Çalışmaya dahil edilen hastalardan 2 (%4,5)’sinin herhangi bir şikayeti bulunmazken, 31 (%70,5) hastada karın ön duvarında kitle ve 39 (%88,6) hastada ise ağrı şikayeti bulunmaktaydı. ADE’nin 23 (%52,3) hastada pfannenstiel insizyonun sol lateralinde ve 17 (%38,6) hastada ise pfannenstiel insizyonun sağ lateralinde olmak üzere, büyük çoğunluğunun pfannenstiel insizyon hattında olduğu tespit edildi. Hastaların 34’ünde preoperatif tanı aracı olarak abdominal ultrasonografi (US) ve 10 hastada da abdominapelvik bilgisayarlı tomografi (BT) kullanılmıştır. Abdominal US’nin doğruluk oranının %85,2, abdominopelvik BT’nin doğruluk oranının ise %50 olduğu belirlenmiştir. Serimizdeki takip oranı %95,4 iken, takip süresi median değerinin 36,5 ay (13-57) olduğu gösterilmiştir. Ayrıca takipteki hastalardan birinde rekürrens geliştiği görülmüştür.
Sonuç: ADE, jinekolojik girişim öyküsü olan ve abdominal insizyon bölgesinde siklik ağrı ve şişlik ile gelen reprodüktif çağdaki tüm kadınlarda akla gelmelidir. Preoperatif tanı için, hastanın öyküsü ayrıntılı olarak sorgulanmalı; dikkatli bir fizik muayene yapılmalı ve tanı için abdominal US kullanılmalıdır. Tedavide cerrahi eksizyon tercih edilmelidir.
Anahtar Kelimeler
Kaynakça
- 1. Nezhat FR, Shamshirsaz AA, Yildirim G. Pelvic pain, endometriosis, and the role of the gynecologist. Pediatric, Adolescent and Young Adult Gynecology. 1st ed. New Jersey: Wiley-Blackwell; 2009:174-94.
- 2. Alessandro P, Luigi N, Felice S, Maria PA, Benedetto MG, Stefano A. Research development of a new GnRH antagonist (Elagolix) for the treatment of endometriosis: A review of the literature. Arch Gynecol Obstet 2017; 295: 827-32.
- 3. Sarma D, terBrugge KG, Gentili F, Halliday W. Cerebellar Endometriosis. AJR Am J Roentgenol 2004; 182: 1543-6.
- 4. Huang H, Li C, Zarogoulidis P et al. Endometriosis of the lung: report of a case and liter- ature review. Eur J Med Res 2013; 18: 13.
- 5. Leite GKC, de Carvalho LFP, Korkes H et al. Scar endometrioma following obstetric surgical incisions: retrospective study on 33 cases and review of the literature. Sao Paulo Med J 2009; 127: 270–7.
- 6. Uçar MG, Şanlıkan F, Göçmen A. Surgical treatment of scar endometriosis following cesarean section, a series of 12 cases. Indian J Surg 2015; 77: 682–6.
- 7. Rindos NB, Mansuria S. Diagnosis and management of abdominal wall endometriosis: a systematic review and clinical recommendations. Obstet Gynecol Surv 2017; 72: 116-22.
- 8. Blanco RG, Parithivel VS, Shah AK, Gumbs MA, Schein M, Gerst PH. Abdominal wall endometriomas. Am J Surg 2003; 185: 596-8.
- 9. Chang Y, Tsai EM, Long CY, Chen YH, Kay N. Abdominal wall endometriomas. J Reprod Med 2009; 54: 155–9.
- 10. Horton JD, Dezee KJ, Ahnfeldt EP, Wagner M. Abdominal Wall endometriosis: A surgeon’s perspective and review of 445 cases. Am J Surg 2008; 196: 207-12.
- 11. Nominato NS, Prates LF, Lauar I, Morais J, Maia L, Geber S. Caesarean section greatly increases risk of scar endome- triosis. Eur J Obstet Gynecol Reprod Biol 2010; 152: 83–5.
- 12. Taburiaux L, Pluchino N, Petignat P, Wenger JM. Endometriosis-associated abdominal wall cancer: a poor prognosis? Int J Gynecol Cancer 2015; 25: 1633-8.
- 13. Ferrandina G, Palluzzi E, Fanfani F et al. Endometriosis-associated clear cell carcinoma arising in caesarean section scar: a case report and review of the literature. World J Surg Oncol 2016; 14: 300.
- 14. Modesitt SC, Tortolero-Luna G, Robinson JB, Gershenson DM, Wolf JK. Ovarian and extraovarian endometriosis- associated cancer. Obstet Gynecol 2002; 100: 788-95.
- 15. Khachani I, Filali Adib A, Bezad R. Cesarean scar endometriosis: An uncommon surgical complication on the rise? Case report and literature review. Case Rep Obstet Gynecol 2017; 80: 629-24.
- 16. Bektas H, Bilsel Y, Sari YS et al. Abdominal wall endo- metrioma; a 10-year experience and brief review of the literature. J Surg Res 2010; 164: e77–e81.
- 17. Fernandez-Acenero MJ, Cordova S. Cutaneous endome- triosis: review of 15 cases diagnosed at a single institution. Arch Gynecol Obstet 2011; 283: 1041–4.
- 18. Oh EM, Lee WS, Kang JM, Choi ST, Kim KK, Lee WK. A surgeon’s perspective of abdominal wall endometriosis at a caesarean section incision: Nine cases in a single institution. Surg Res Pract 2014; 2014: 765372.
- 19. Medeiros Fd, Cavalcante DI, Medeiros MA, Eleutério J Jr. Fine- needle aspiration cytology of scar endometriosis: Study of seven cases and literature review. Diagn Cytopathol 2011; 39: 18-21.
- 20. Savelli L, Manuzzi L, Donato ND et al. Endometriosis of the abdominal wall: ultrasonographic and doppler characteristics. Ultrasound Obstet Gynecol 2011; 10052: 132.
- 21. Song HK, Lee SH, Kim MJ, Shin JE, Lee DW, Lee HN. Abdominal wall mass suspected of endometriosis: clinical and pathologic features. Obstet Gynecol Sci 2020; 63: 357-62.
- 22. Patterson GK, Winburn GB. Abdominal wall endometriomas: Report of eight cases. Am Surg 1999; 65: 36-9.
- 23. Grigore M, Socolov D, Pavaleanu I, Scripcariu I, Grigore AM, Micu R. Abdominal wall endometriosis: an update in clinical, imagistic features, and management options. Med Ultrason 2017; 19: 430-7.
- 24. Purvis RS, Tyring SK. Cutaneous and subcutaneous endome- triosis. Surgical and hormonal therapy. J Derm Surg Oncol 1994; 20: 693-5.
- 25. Kim SM, Kim HK, Namkung J et al. A case of reconstruction of abdominal fascia using polypropylene mesh for patient of abdominal wall endometriosis after cesarean section. Korean J Obstet Gynecol 2012; 55: 517-21.
- 26. Khan Z, Zanfagnin V, El-Nashar SA, Famuyide AO, Daft- ary GS, Hopkins MR. Risk factors, clinical presentation, and outcomes for abdominal wall endometriosis. J Minim Invasive Gynecol 2017; 24: 478-84.
Öz
Aim: The aim of this study is to evaluate demographic and clinical characteristics, diagnostic tools, surgical options and recurrence rates in patients with abdominal wall endometriosis (AWE).
Material and Methods: 44 patients who were operated for AWE in our clinic between January 2015 and January 2020 were included in the study. Demographic data of the patients, operation history, clinical features, imaging method used for diagnosis, type of operation performed and recurrence status were evaluated.
Results: The median age of the patients included in the study was determined as 35 (26-48). While 1 (2.3%) of the patients did not have a history of abdominal operation; 39 (88.6%) patients had cesarean section (C / S), 2 (4.5%) patients had myomectomy and 2 (4.5%) patients had hysterectomy history. In addition, 2 (4.5%) of the patients included in the study had no complaints, while 31 (70.5%) patients had a mass in the anterior abdominal wall and 39 (88.6%) patients had pain. AWE was in the left lateral of the pfannenstiel incision in 23 (52.3%) patients and in the right lateral of the pfannenstiel incision in 17 (38.6%) patients; the majority of them were found to be in the pfannenstiel incision. Abdominal ultrasonography (US) was used as a preoperative diagnostic tool in 34 of the patients and abdominapelvic computed tomography (CT) was used in 10 patients. It was determined that the accuracy rate of abdominal US was 85.2%, and the accuracy rate of abdominopelvic CT was 50%. While the follow-up rate in our series was 95.4%, the median value of follow-up period was 36.5 months (13-57). In addition, recurrence was observed in one of the patients followed up.
Conclusion: AWE should be considered in all women of reproductive age who have a history of gynecological intervention and present with cyclic pain and swelling at the abdominal incision. For preoperative diagnosis, the patient's history should be questioned in detail; a careful physical examination should be performed, and abdominal US should be used for diagnosis. Surgical excision should be preferred in treatment.
Anahtar Kelimeler
Kaynakça
- 1. Nezhat FR, Shamshirsaz AA, Yildirim G. Pelvic pain, endometriosis, and the role of the gynecologist. Pediatric, Adolescent and Young Adult Gynecology. 1st ed. New Jersey: Wiley-Blackwell; 2009:174-94.
- 2. Alessandro P, Luigi N, Felice S, Maria PA, Benedetto MG, Stefano A. Research development of a new GnRH antagonist (Elagolix) for the treatment of endometriosis: A review of the literature. Arch Gynecol Obstet 2017; 295: 827-32.
- 3. Sarma D, terBrugge KG, Gentili F, Halliday W. Cerebellar Endometriosis. AJR Am J Roentgenol 2004; 182: 1543-6.
- 4. Huang H, Li C, Zarogoulidis P et al. Endometriosis of the lung: report of a case and liter- ature review. Eur J Med Res 2013; 18: 13.
- 5. Leite GKC, de Carvalho LFP, Korkes H et al. Scar endometrioma following obstetric surgical incisions: retrospective study on 33 cases and review of the literature. Sao Paulo Med J 2009; 127: 270–7.
- 6. Uçar MG, Şanlıkan F, Göçmen A. Surgical treatment of scar endometriosis following cesarean section, a series of 12 cases. Indian J Surg 2015; 77: 682–6.
- 7. Rindos NB, Mansuria S. Diagnosis and management of abdominal wall endometriosis: a systematic review and clinical recommendations. Obstet Gynecol Surv 2017; 72: 116-22.
- 8. Blanco RG, Parithivel VS, Shah AK, Gumbs MA, Schein M, Gerst PH. Abdominal wall endometriomas. Am J Surg 2003; 185: 596-8.
- 9. Chang Y, Tsai EM, Long CY, Chen YH, Kay N. Abdominal wall endometriomas. J Reprod Med 2009; 54: 155–9.
- 10. Horton JD, Dezee KJ, Ahnfeldt EP, Wagner M. Abdominal Wall endometriosis: A surgeon’s perspective and review of 445 cases. Am J Surg 2008; 196: 207-12.
- 11. Nominato NS, Prates LF, Lauar I, Morais J, Maia L, Geber S. Caesarean section greatly increases risk of scar endome- triosis. Eur J Obstet Gynecol Reprod Biol 2010; 152: 83–5.
- 12. Taburiaux L, Pluchino N, Petignat P, Wenger JM. Endometriosis-associated abdominal wall cancer: a poor prognosis? Int J Gynecol Cancer 2015; 25: 1633-8.
- 13. Ferrandina G, Palluzzi E, Fanfani F et al. Endometriosis-associated clear cell carcinoma arising in caesarean section scar: a case report and review of the literature. World J Surg Oncol 2016; 14: 300.
- 14. Modesitt SC, Tortolero-Luna G, Robinson JB, Gershenson DM, Wolf JK. Ovarian and extraovarian endometriosis- associated cancer. Obstet Gynecol 2002; 100: 788-95.
- 15. Khachani I, Filali Adib A, Bezad R. Cesarean scar endometriosis: An uncommon surgical complication on the rise? Case report and literature review. Case Rep Obstet Gynecol 2017; 80: 629-24.
- 16. Bektas H, Bilsel Y, Sari YS et al. Abdominal wall endo- metrioma; a 10-year experience and brief review of the literature. J Surg Res 2010; 164: e77–e81.
- 17. Fernandez-Acenero MJ, Cordova S. Cutaneous endome- triosis: review of 15 cases diagnosed at a single institution. Arch Gynecol Obstet 2011; 283: 1041–4.
- 18. Oh EM, Lee WS, Kang JM, Choi ST, Kim KK, Lee WK. A surgeon’s perspective of abdominal wall endometriosis at a caesarean section incision: Nine cases in a single institution. Surg Res Pract 2014; 2014: 765372.
- 19. Medeiros Fd, Cavalcante DI, Medeiros MA, Eleutério J Jr. Fine- needle aspiration cytology of scar endometriosis: Study of seven cases and literature review. Diagn Cytopathol 2011; 39: 18-21.
- 20. Savelli L, Manuzzi L, Donato ND et al. Endometriosis of the abdominal wall: ultrasonographic and doppler characteristics. Ultrasound Obstet Gynecol 2011; 10052: 132.
- 21. Song HK, Lee SH, Kim MJ, Shin JE, Lee DW, Lee HN. Abdominal wall mass suspected of endometriosis: clinical and pathologic features. Obstet Gynecol Sci 2020; 63: 357-62.
- 22. Patterson GK, Winburn GB. Abdominal wall endometriomas: Report of eight cases. Am Surg 1999; 65: 36-9.
- 23. Grigore M, Socolov D, Pavaleanu I, Scripcariu I, Grigore AM, Micu R. Abdominal wall endometriosis: an update in clinical, imagistic features, and management options. Med Ultrason 2017; 19: 430-7.
- 24. Purvis RS, Tyring SK. Cutaneous and subcutaneous endome- triosis. Surgical and hormonal therapy. J Derm Surg Oncol 1994; 20: 693-5.
- 25. Kim SM, Kim HK, Namkung J et al. A case of reconstruction of abdominal fascia using polypropylene mesh for patient of abdominal wall endometriosis after cesarean section. Korean J Obstet Gynecol 2012; 55: 517-21.
- 26. Khan Z, Zanfagnin V, El-Nashar SA, Famuyide AO, Daft- ary GS, Hopkins MR. Risk factors, clinical presentation, and outcomes for abdominal wall endometriosis. J Minim Invasive Gynecol 2017; 24: 478-84.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Özgün Makale |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Mart 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 12 Sayı: 1 |
Kaynak Göster
e-ISSN: 2149-8296
The content of this site is intended for health care professionals. All the published articles are distributed under the terms of
Creative Commons Attribution Licence,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.