Abdominal Incisional Endometriosis: Report Of 50 Cases

Aims: Endometriosis is a common gynecological disorder characterized by the presence of ectopic endometrial-like tissue (glands and stroma epithelial cells) outside the uterus, which can cause progressive dysmenorrhea, non-cyclical pelvic pain, menstrual disorders and infertility. Although endometriosis is pathologically benign, its clinical features are similar to the malignant tumors, including local infiltration, planting and distant metastasis. It also goes with a relatively high rate of recurrence. Despite decades of extensive research, the pathogenesis of endometriosis remains poorly understood. The pathological changes of endometriosis is mainly characterized by nodules and cysts caused by the repeated bleeding and reabsorption of the ectopic endometrial tissue. To summarize the characteristics of the pathogenesis and clinical manifestations of endometriosis and establish the evaluation system for the latency-associated factors.Methods:The clinical data of 50 cases of abdominal incisional endometriosis between January 2002 and December 2009 in Xijing Hospital were collected, and the retrospective analysis of clinical manifestations, diagnosis and treatment endometriosis was performed.Results:1,50 cases were all with a history of cesarean section. 2,90% of the cases were of transverse incision lesions (45/50) and 10% are of vertical incision lesions (5/50). Lesions of 22 cases were on the right of the midline and those of 18 cases were on the left of the midline. 3,Most of the lesions were single and mainly located between the subcutaneous fat layer and the sheath. 4,Typical symptoms of progressive abdominal incision menstrual pain accompanied with mass growth were observed in 48 cases, while the other 2 cases were with no obvious symptoms. 5,The average latent period of abdominal incisional endometriosis with vertical incision was 39.5 months. Latency of endometriosis was positively related with age before the age of 40. The characteristics of the patients with a shorter latency were as follows:①menarche age between 12 and 14;②over 7-day duration of menstrual period;③past history of miscarriage;④lesions that were located between the subcutaneous fat layer and the sheath. (6) Ultrasound is of great benefit in the diagnosis of incisional endometriosis.Conclusions: 1.Incisional endometriosis after cesarean section was mainly due to the iatrogenic planting of endometrium during pelvic surgery operation. 2.Its incidence is closely related with genetic characteristics of endometrial fragments, biological activity and the factors of the patients. 3.The invasive places which always occur as single lesion are mostly observed from subcutaneous tissue to the front sheath of rectus abdominis. 4.The latent period is related with age of menarche and cesarean section, duration of menstrual period, and the location of the lesion. The diagnosis is made based on the clinical manifestations and ultrasound scanning. 5.The complete excision of lesions is the priority in the treatment of endometriosis, and it is of poor effect when the mono-medicine therapy is used. However, proper drug use after the surgery is of great benefit for preventing its recurrence. 6.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.