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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2007 August;20(4):177-81
Incisional endometriosis: clinical case and diagnostic-therapeutic considerations
Candela G., Varriale S., Di Libero L., Manetta F., Giordano M., Maschio A., Lanza M., Argenziano M., Napolitano S., Santini L.
VII Divisione di Chirurgia Generale Facoltà di Medicina e Chirurgia Seconda Università degli Studi di Napoli, Napoli
Endometriosis, which Sampson defined as the presence of endometrial tissue outside the uterine cavity, usually has its implantation at the pelvic and abdominal level; it is rare to find endometriotic tissue in the abdominal wall (0,5-1% of the extra-abdominal implantations). Depending on the pathogenesis, endometriosis can be distinguished as primitive or secondary.
The primitive shape is awardable to dysembryogenetic phenomenons, while the secondary to the dissemination of endometrial tissue in the abdominal wall during surgical and diagnostic maneuvers.
In abdominal wall the places where the implantation is more frequent seem to be the umbilicus and the rectum muscles, although its localization in the inguinal canal has been described too. We present a clinical case of a pluripara young woman for which we suspected the existence of a small laparoceles due to pain and to the presence of a tumefaction in correspondence of a scar which was consequence of a previous cesarean incision.
During the surgery operation of abdominal plastic, in the muscular layer of the abdominal wall it was put in evidence some ectopic tissues, defined then, after histologic test, as endometrial tissues.
Although instrumental diagnostics (generally echography and computerized tomography) helps a lot in the diagnostic orientation, only the histologic test can give the diagnostic certitude.
For endometriosis of abdominal wall it is necessary the differential diagnosis with spontaneous hematoma of the rectum muscle, Spigelio hernias, tumors of the abdominal wall and with laparoceles. In the present time the surgical resection, even enlarged, represents the therapy with the smallest rate of recidives.
The medical therapy, instead is indicated especially for the numerous collateral effects that it shows.