Research
Gynecology
Abdominal wall endometriosis: 12 years of experience at a large academic institution

Presented in poster format at the 40th Annual Scientific Meeting of the Society of Gynecologic Surgeons, Scottsdale, AZ, March 23-26, 2014.
https://doi.org/10.1016/j.ajog.2014.04.011Get rights and content

Objective

The objective of the study was to review patient characteristics and intraoperative findings for excised cases of abdominal wall endometriosis (AWE).

Study Design

A 12 year medical record search was performed for cases of excised AWE, and the diagnosis was confirmed on pathological specimen. Descriptive data were collected and analyzed.

Results

Of 65 patients included, the primary clinical presentation was abdominal pain and/or a mass/lump (73.8% and 63.1%, respectively). Most patients had a history of cesarean section (81.5%) but 6 patients (9.2%) had no prior surgery. Time from the initial surgery to presentation ranged from 1 to 32 years (median, 7.0 years), and time from the most recent relevant surgery ranged from 1 to 32 years (median, 4.0 years). Five patients (7.7%) required mesh for fascial closure following the resection of the AWE. We were unable to demonstrate a correlation between the increasing numbers of open abdominal surgeries and the time to presentation or depth of involvement. Age, body mass index, and parity also were not predictive of depth of involvement. There were increased rates of umbilical lesions (75% vs 5.6%, P < .001) in nulliparous compared with multiparous women as well as in women without a history of cesarean section (66.7% vs 1.9%, P < .001).

Conclusion

In women with a mass or pain at a prior incision, the differential diagnosis should include AWE. Although we were unable to demonstrate specific characteristics predictive for AWE, a large portion of our population had a prior cesarean section, suggesting a correlation.

Section snippets

Materials and Methods

Following approval by the University of Pittsburgh Institutional Review Board, a retrospective review was performed of all hospital and office charts of patients treated for AWE at the University of Pittsburgh Medical Center between March 2001 and April 2013. Cases were identified by International Classification of Diseases, ninth revision, codes and confirmed via pathological specimen diagnosis (Figure 1). Cases were excluded if endometriosis was limited to the peritoneal layer alone.

Chart

Results

A search based on the International Classification of Diseases, ninth revision, identified 98 potential subjects of which 90 records were available for review. An additional 25 subjects were excluded for either lack of pathologically confirmed endometriosis or endometriosis limited to the peritoneal cavity. Ultimately, 65 subjects who underwent the excision of pathologically confirmed AWE by a variety of subspecialty surgeons at our institution between March 2001 and April 2013 were analyzed.

Comment

Our retrospective review identified 65 cases of pathology-confirmed AWE over 12 years. A large majority of our patients were white, overweight or obese, and multiparous, which likely represents the population demographics within which this study was performed.13 Our hypothesis prior to initiation of this study was that increased numbers of cesarean sections with further distortion of tissue planes and anatomy would increase depth of involvement at time of excision and/or decrease time to

Acknowledgment

We thank Dr Gabriela Quiroga-Garza for providing pathology photos.

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      Citation Excerpt :

      Endometrial cells are iatrogenically transplanted into the surgical incision, and over time the endometriosis grows and proliferates in response to hormonal stimulation. The incidence of AWE following a cesarean delivery is 0.5% to 1% and is not related to the number of prior cesarean deliveries, timing of delivery, or reason for cesarean delivery.3,4,22 AWE after cesarean delivery presents a singular nodule in the apices of the Pfannenstiel incision without concurrent pelvic endometriosis.

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    The authors report no conflict of interest.

    Reprints not available from the authors.

    Cite this article as: Ecker AM, Donnellan NM, Shepherd JP, et al. Abdominal wall endometriosis: 12 years of experience at a large academic institution. Am J Obstet Gynecol 2014;211:363.e1-5.

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