Zafer TÜRKYILMAZ, Ramazan KARABULUT, A Can BAŞAKLAR, Serdar MORALIOĞLU, Çağatay E. AFŞARLAR, Nuri KALE

Çocukta nadir bir akut karın sebebi: Endometriotik kist

Endometriozis, endometrium dokusunun normal lokalizasyonunun dışında bir lokalizasyonda bulunmasıdır. Kronik pelvik ağrı hikayesi olan adolesanların %25-38’ inde endometriozis tespit edilmiştir. Bu çalışma ile, çocukta nadir akut karın sebebi olarak saptanan bir endometriotik kist olgusunu sunmak istedik. On beş yaşındaki hasta, sol alt kadran ağrısı ve kusma şikayetleri ile kliniğimize başvurduğunda fizik muayenesinde akut karın bulguları vardı. Pelvik ultrasonografisinde sol over torsiyonu ve subseröz myom izlenen hasta operasyona alındı. Eksplorasyonda overlerde sadece follikül kistleri mevcutken, uterus kubbesinde, üzerinde kanama odağı izlenen nekrotik görünümlü subseröz myomla uyumlu lezyon izlendi. Kitle eksize edildi. Patolojik incelemede bu lezyon endometriotik kist olarak tanı aldı. Adolesanlarda akut karının nadir sebeplerinden biri olan endometriotik kistlerin ameliyat öncesinde, hatta ameliyat sırasında dahi tanısı güçtür.

A rare cause of acute abdomen in children: Endometriatic cyst

Endometriosis is characterized by the presence of endometrial tissue outside the normal location. In adolescents with a history of chronic pelvic pain, studies have reported a 25-38% incidence of endometriosis. We present a case of an endometriotic cyst that was the cause of acute abdomen. A 15-year old girl was admitted with left lower quadrant abdominal pain and vomiting. During the examination there were acute abdomen findings and ultrasonography diagnosed a left ovarian torsion and subserosal myoma uteri. During the operation, there was hemorrhagic fluid in the abdomen, the left ovary had no torsion but both of the ovaries had follicle cysts, and on the upper side of the corpus uteri there was a hemorrhagic subserous myoma that had hemorrhage and necrosis. The lesion on the corpus uteri was excised completely. The pathological diagnosis of the lesion revealed an endometriotic cyst. The accurate diagnosis of endometriotic cysts before or during surgery is difficult because of its rarity.

PDF

___

1. Black AY, Jamieson MA. Adolescent endometriosis. Curr Opin Obstet Gynecol 2002; 14: 467-474.
2. Bedaiwy MA, Falcone T. Laboratory testing for endometriosis. Clin Chim Acta 2004; 340: 41-56.
3. Laufer MR, Goitein L, Bush M, et al. Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy. J Pediatr Adolesc Gynecol 1997; 10: 199-202.
4. Goldstein DP, DeCholnoky C, Emans SJ. Adolescent endometriosis. J Adolesc Health Care 1980; 1: 37-41.
5. Chatman DL, Ward AB. Endometriosis in adolescents. J Reprod Med 1982; 27: 156-160.
6. Bennett GL, Harvey WB, Slywotzky CM, et al. CT of the acute abdomen: gynecologic etiologies. Abdom Imaging 2003; 28: 416-432.
7. Koninckx PR, Meuleman C, Demeyere S, et al. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 1991; 55: 759-765.
8. ACOG Committee Opinion Number 310. Endometriosis in Adolescents. Obstet Gynecol 2005; 105: 921-927.
9. Laufer MR. Identification of clear vesicular lesion of atypical endometriosis: a new technique. Fertil Steril 1997; 68: 739-740.
10. Fedele L, Arcaini L, Vercellini L, et al. Serum CA 125 measurements in the diagnosis of endometriosis recurrence. Obstet Gynecol 1988; 72: 19-22.
11. Harada T, Kubota T, Aso T. Usefulness of CA 19-9 versus CA 125 for the diagnosis of endometriosis. Fertil Steril 2002; 78: 733-739.
12. Laufer MR, Goldstein DP: Dysmenorrhea, Pelvic Pain, and the Premenstrual Syndrome. In Emans SJ, Laufer MR, Goldstein DP: Pediatric and Adolescent Gynecology. Lippincott-Raven, 1998, P:363- 410.
13. Sutton J, Ewan SP, Whitelaw N, et al. Prospective, randomized, double blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild and moderate endometriosis. Fertil Steril 1994; 64: 696-700.
14. Redwine DB. Treatment of endometriosis-associated pain. Infertil Reprod Med Clin North Am 1993; 3: 697-721.
15. Guidice LC, Kao LC. Endometriosis. Lancet 2004; 364: 1789-1799. 16. Swiersz LM. Role of endometriosis in cancer and tumor development. Ann NY Acad Sci 2001; 955: 281-292.