From the Abstract Archives of the Journal of the American College of
the Abstract Archives of the Journal
of the American College of Surgeons (c)
copyright April 2000
of the American College of Surgeons (JACS) is a monthly journal publishing
peer-reviewed original contributions on all aspects of surgery. These
contributions include but are not limited to original clinical studies, review
articles, and experimental investigations with clear clinical relevance.
Incisional Endometriosis: an Underappreciated Diagnosis in General
Am Coll Surg 2000
Apr;190(4):404-7 (ISSN: 1072-7515)
By Nirula R; Greaney GC Department of
Surgery, Santa Barbara Cottage Hospital, CA 93105, USA.
endometriosis is a described dinical entity in the gynecologic literature, but
it is not well recognized among general surgeons; only 32 cases have been
reported in the general surgery literature. The preoperative diagnosis is often
mistaken for a suture granuloma, lipoma, abscess, cyst, or incisional hernia.
STUDY DESIGN: We performed a
retrospective review of 10 cases of incisional endometriosis at our institution
to determine which, if any, clinical factors would suggest the diagnosis
preoperatively. All general surgery patients who had the diagnosis of
endometriosis in their pathology specimens from January 1990 to December 1998
RESULTS: All 10 patients had
previous cesarean sections through either a Pfannenstiel (n = 8) or a lower
midline (n = 2) incision. Ages ranged from 27 to 41 years (mean 33.4 years). The
most common presenting symptom was a slow-growing, painful lump in the lateral
aspect of the Pfannenstiel incision. Two of the patients had a change in
symptoms with their menstrual cycle. The duration of symptoms ranged from 2
months to 3 years. All patients underwent surgical excision. The size of the
excised endometriomas ranged from 1.5 cm to 4.8 cm (mean 3.1 cm).
endometriosis may be more common than previously recognized. In all cases it was
found to occur in women with a history of cesarean section. Most patients
presented with a painful, slow-growing lump at the lateral edge of their
incision. Cyclic changes in pain and size of the mass with menses was elicited
in only two of these patients, but this may be from a lack of awareness and
questioning on the part of the physician. If the diagnosis is made
preoperatively, additional diagnostic studies may be avoided. An awareness of
this disease process on the part of general surgeons is necessary to guide
preoperative evaluation and therapy appropriately.