From the Abstract Archives of the Journal of the American College of Surgeons (c) copyright April 2000

The Journal 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 Surgery

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.

BACKGROUND:  Incisional 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 were reviewed.

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).

CONCLUSIONS: Incisional 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.