Abdominal Incisional Endometriosis After Cesarean Section: Report Of Eleven Cases

Objective:Abdominal incisional endometriosis after cesarean section is rare endometriosis outside the pelvic, and is also a long-term complica-tion of cesarean section. Majority of scholars believe that the main reason of it may be functioning endometrial tissue is left and planted directly in the abdominal wall when cesarean section is given. With the increasing rate of cesarean section in recent years, the number of cases has also a trend of increasing. Although it is not a life-threatening disease, but the cyclical increase of abdominal mass and pain during menses has brought patients some pain. While abdominal incisional endometriosis can be prevented and morbidity can be reduced through the effective ways, so it deserves clinical attention. The related risk factors will be investigated to provide clinical reference aiming at reducing its incidence in future through a retrospective analysis of clinical features, diagnosis and treatment of abdominal incision-al endometriosis.Methods:The clinical data of 11 cases of abdominal incisional endom-etriosis between January 1998 and December 2009 at our hospital was collected, and a retrospective analysis of clinical features, diagnosis and treatment was performed.Results:All patients had a history of cesarean section, and 10 of them had a history of cesarean section for the full-term pregnancy, and 1 for the medium-term pregnancy. All the patients had the insecondary cyclical pain in the scar interrelated with menses, a nodule or mass will be found in the place of pain, and physical examination found that the nodule or mass is almost tough, tenderness with less clear boundaries to the organization around. The right diagnosis can be made before the operation according to patients'history, signs and sonographic features, and can coincide with the pathological findings after the operation. There were significant positive correlation (p both <0.01)among patients'age, the time of postpartum lactating, the time of menstruation after the childbirth and the incubation (the time between the onset of clinical symptoms and signs and initial surgery is called the incubation);The average period of incubation is 28 months (6 to 54 months), and 72.73%(8/11) of the patient has the onset of symptoms in three years; transverse incision is more common, accounting for 72.73%(8/11); The lesion place was more to seen from subcutaneous tissue to front sheath of rectus, in this group accounted for 81.82%(9/11); Single lesion was more be seen, accounting for 90.91%(10/11 cases); Ultrasound test is the main diagnostic methods of auxiliary examination, and its diagnose accordance rate is high.All of these patients has a ultrasound test before the operation, and the result can coincide with the pathological findings after the operation; before the surgery, there were four patients using drugs (progesterone) treatment for 2 to 3 months, because the pain was not significant lessening and the mass has not been reduced, finally,they stopped drug treatment and chose surgery treatment. All the patients underwent surgery with complete excision of the lesion, and tissues around the lesion, postoperative follow-up showed there was no recurrence up to now.Conclusion:Endometrium implanting theory is the main pathogenesis for abdominal incisional endometriosis after cesarean section. Its incidence has some relationship to genetic characteristics of endometrial fragments, biological activity and the patient's own factors. The invasive places which always occur as single lesion are almost seen from subcutaneous tissue to front sheath of rectus abdominis. Generally, the diagnosis can be made according to the patients'typical clinical manifestation and auxiliary examination such as test of B-ultrasound. Strictly obeying the indication for cesarean section and ruling the operative procedure is the main way to reduce the incidence of abdominal incisional endometriosis after cesarean section, and insisting on breastfeeding after cesarean sections have some preventive effect on the incidence of the disease.