Abdominal Duvar Endometriozis: Tanı ve Tedavisinde KlinikDeneyimimiz, 69 Hastanın Analizi

GİRİŞ ve AMAÇ: Bu çalışmanın amacı histopatolojik olarakkanıtlanmış abdominal duvar endometriozis (ADE) vakalarınınklinik özelliklerini ve intraoperatif bulgularınıdeğerlendirmektir. YÖNTEM ve GEREÇLER: Bu retrospektif çalışmada, Mart2008-Nisan 2018 tarihleri arasında İstanbul Bakırköy Dr. SadiKonuk Eğitim ve Araştırma Hastanesi'nde abdominal duvarendometriozisi tanısı alan hastaların bilgisayar tabanlı tıbbikayıtları incelendi ve analiz edildi. BULGULAR: Çalışmaya dahil edilen 69 hastanın %85’inin(59/69) daha önce geçirilmiş sezeryanla doğum öyküsümevcuttu. Ayrıca hastaların çoğunluğu aşırı kiloluydu (%69.6,48/69). Hastaların primer klinik persentasyonu karın ağrısı vecilt altında ele gelen şişlikti (sırasıyla%77,4 ve %67,3). Diğerilişkili semptomlar arasında dismenore, disparoni,barsak veüriner semptomları bulunmaktaydı. Semptomlarınbaşlangıcından eksizyona kadar geçen süre ortalama 1,7±0,8yıldı. Eksize edilen endometriotik dokunun ortalama çapı3,2±1,4, en büyük lezyonun çapı 8 cm’idi. Lezyonların büyükçoğunluğu subkutan dokuda yerleşimliydi. Eksizyon sonrası 3(%4.3) hastada endometriozis tekrarladı ve bu hastalarareeksizyon öncesi preoperatif radyolojik işaretleme yapıldı.İlginç olarak 2 hastada operasyon öyküsü yoktu. Buolgulardaki endometriozis inguinal bölgede olduğu içinoperasyon genel cerrahlar tarafından yapıldı. TARTIŞMA ve SONUÇ: ADE lezyonlarının çoğunluğununsezeryan skarıyla ilişkili olması, bu hastaların çok azına meshgereksinimi duyulması ve nüksün az olması, uygun eksizyonlahastaların tedavisin başarıyla yapılabileceğini göstermektedir.

Abdominal Wall Endometriosis: Our Clinical Experience in Diagnosis and Treatment, Analysis of 69 Patients

INTRODUCTION: The aim of this study is to evaluate theclinical features and intraoperative findings ofhistopathologically confirmed cases of abdominal wallendometriosis (AWE). METHODS: : In this retrospective study, computer-basedmedical records of patients diagnosed with abdominal wallendometriosis at Istanbul Bakırköy Dr. Sadi Konuk Trainingand Research Hospital between March 2008 and April 2018were examined and analyzed. RESULTS: Of the 69 patients included in the study, 85%(59/69) had a previous cesarean delivery history. In addition,the majority of patients were overweight (69.6%, 48/69). Theprimary clinical persistence of the patients was abdominalpain and swelling under the skin (77.4% and 67.3%,respectively). Other related symptoms included dysmenorrhea,dyspareunia, intestinal and urinary symptoms. The mean timefrom onset of symptoms to excision was 1.7 ± 0.8 years. Themean diameter of the excised endometriotic tissue was 3.2 ±1.4, and the diameter of the largest lesion was 8 cm. The vastmajority of the lesions were located in the subcutaneous tissue.Endometriosis recurred in 3 (4.3%) patients after excision, andthese patients underwent preoperative radiological markingbefore re-excision. Interestingly, 2 patients did not have ahistory of operation. Since the endometriosis in these cases isin the inguinal region, the operation was performed by generalsurgeons. DISCUSSION AND CONCLUSION: The fact that themajority of AWE lesions are associated with cesarean scar,very few of these patients require mesh and lov recurrenceshows that patients can be successfully treated withappropriate excision.

PDF

___

1-Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012;98:511-519.
2-Bulun SE. Endometriosis. N Engl J Med 2009;360:268-279.
3-Nominato NS, Prates LF, Lauar I, Morais J, Maia L, Geber S. Caesarean section greatly increases risk of scar endometriosis. Eur J Obstet Gynecol Reprod Biol. 2010;152:83-85.
4-Blanco RG, Parithivel VS, Shah AK, Gumbs MA, Schein M, Gerst PH. Abdominal wall endometriomas. Am J Surg. 2003;185:596-598.
5-Gidwaney R, Badler RL, Yam BL, et al. Endometriosis of abdominal and pelvic wall scars: multimodality imaging findings, pathologic correlation, and radiologic mimics. Radiographics 2012;32:2031-2043.
6-Horton JD, Dezee KJ, Ahnfeldt EP, Wagner M. Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases. Am J Surg. 2008;196:207-212.
7-Leite GKC, de Carvalho LFP, Korkes H, Guazzelli TF, Kenj G, 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.
8-Horton JD, Dezee KJ, Ahnfeldt EP, Wagner M. Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases. Am J Surg. 2008;196:207-212.
9-Khan Z, Zanfagnin V, El-Nashar SA, et al. Risk Factors, Clinical Presentation, and Outcomes for Abdominal Wall Endometriosis. J Minim Invasive Gynecol. 2017;24:478-484.
10-Rindos NB, Mansuria S. Diagnosis and Management of Abdominal Wall Endometriosis: A Systematic Review and Clinical Recommendations. Obstet Gynecol Surv. 2017;72:116-122.
11-Leite GKC, Carvalho LFP, Korkes H, Guazzelli TF, Kenj G, Viana AT. Scar endometrioma following obstetric surgical incisions: retrospective study on 33 cases and review of the literature. Sao Paulo Medical Journal. 2009;127(5):270-277.
12-Harry VN, Shanbhag S, Lyall M, Narayansingh GV, Parkin DE. Isolated clear cell adenocarcinoma in scar endometriosis mimicking an incisional hernia. Obstet Gynecol. 2007;110: 469-471.
13-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(4):430-437.
14- Busard MP, Mijatovic V, van Kuijk C, Hompes PG, van Waesberghe JH. Appearance of abdominal wall endometriosis on MR imaging. Eur Radiol. 2010;20(5):1267-1276.
15-Simsir A, Thorner K, Waisman J, Cangiarella J. Endometriosis in abdominal scars: a report of three cases diagnosed by fine-needle aspiration biopsy. Am Surg. 2001;67(10):984-986.
16-Biberoğlu E, Biberoğlu K. [Endometriosis and pelvic pain (evidence based medicine)]. Turkiye Klinikleri J Gynecol Obst-Special Topics. 2010;3(3):54-61.
17- Blanco RG, Parithivel VS, Shah AK, Gumbs MA, Schein M, Gerst PH. Abdominal wall endometriomas. Am J Surg. 2003;185(6):596-598
18- Bektaş H, Bilsel Y, Sari YS, Ersöz F, Koç O, Deniz M, et al. Abdominal wall endometrioma; a 10-year experience and brief review of the literature. J Surg Res. 2010;64(1):77-81.
19- Xiang Y, Lang J, Wang Y, Huang R, Lian L. Abdominal scar endometriosis: report of 28 cases. Chin Med Sci J. 1995;10:188-190.
20-Catalina-Fernandez I, Lopez-Presa D, SaenzSantamaria J. 1 Fine needle aspiration cytology in cutaneous and su