Abdominal duvar endometriozisi; Retrospektif, gözlemsel bir çalışma

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:

Endometriozis, karın duvarı, siklik ağrı, kitle

Abdominal wall endometriosis; A retrospective, observational study

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.

Keywords:

Endometriosis, abdominal wall, cyclic pain, mass,

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