Endometriosis Within the Rectus Muscle and Cesarean Scar: Analysis of 21 Cases and Assessment Potential of Malignancy

INTRODUCTION: Endometriosis is characterized by the growth of endometrial tissue outside the uterus. Although it most frequently localized in the ovaries, it can affect every organ in the abdomen from the appendix to the liver. It is rarely seen in the cesarean scar(c/s) or rectus muscle. Herein, we report 21 case of endometriosis within the rectus muscle and cesarean scars.
METHODS: Between 2008 and 2015,a total of 21 patients who were operated for the mass within the rectus muscle or cesarean scar in the abdominal wall and whose pathological result was consisted with endometriosis were retrospectively analyzed.
RESULTS: Median age of women in the study group was 34.5(24-52). Endometriosis localisation in 11 of the patients were found on the c/s scar, in 9 of them were on the rectus abdominis muscle, and one of them was in the umblical hernia sac. Median size of the endometriosis tissue was measured as 3.4 cm (1.8-7.5 cm) in the specimens. In our study,2 of the patients were given general anesthesia while 19 of them were operated under local anesthesia. Ultrasound imaging were done in all cases and 6 patients were further evaluated using magnetic resonance imaging(MRI). No mortality was reported. As for morbidity, 2 patient had local wound infection. Study group is followed up without any recurrence reported.
DISCUSSION AND CONCLUSION: Endometriosis cases are presented as palpable painful masses and rarely found on C/S scar or on anterior abdominal wall. Surgery is a effective treatment option. To avoid any recurrence, masses must be removed a minumum 1 cm margin. In differential diagnosis of palpable and painful masses on the abdominal wall or C/S scar in reproductive women, we should consider endometriosis.

Sezaryan Skarýnda ve Rektus Kasý Ýçerisinde Görülen Endometriozis: 21 Olgunun Analizi ve Malignite Potansiyelinin Deðerlendirilmesi

GÝRÝÞ ve AMAÇ: Endometriozis endometrium dokusunun uterus dýþýnda baþka bir anatomik bölgede bulunmasýdýr. En sýk overlerde olmak üzere batýn içinde apendiksten karaciðere kadar her organda görülebilir. Sezaryan skarý(c/s) yada rektus kasý içerisinde nadir olarak görülür.Bu çalýþmada sezaryan skarý ve rektus kasý içerisinde görülen 21 olgumuzu sunduk.
YÖNTEM ve GEREÇLER: 2008-2015 yýllarý arasýnda karýn ön duvarýndaki rektus kasý içerisinde veya sezaryan skarýnda kitle nedeniyle opere ettiðimiz ve patoloji sonucu endometriozis olarak deðerlendirilen hastalarý retrospektif olarak inceledik.
BULGULAR: Çalýþmaya alýnan kadýn hastalarýn yaþ ortalamasý 34.5(24-52) olarak hesaplandý. Hastalarýn 11’inde endometriozis dokusu eski sezaryan skarýnda, 9 hastada batýn ön duvarýnda rektus kasý içerisinde görülürken 1 hastada umbikal herni kesesi içerisinde gözlendi. Patoloji piyeslerindeki endometriozis kitlesinin ortalama büyüklüðü 3.4 cm(1.8cm-7.5 cm)olarak ölçüldü. Çalýþmamýzda hastalarýn 2’si genel anestezi altýnda 19’u lokal anestezi altýnda opere edildi. Hastalarýn 15’inde görüntüleme yöntemi olarak ultrason(USG) yapýlýrken, bu hastalarýn altýsýna USG sonrasý ileri tetkik olarak manyetik rezonans(MR) tetkiki yapýldý. Hastalarda mortalite gözlenmezken, iki hastada yara yeri enfeksiyonu görüldü. Nüks gözlenmeyen hastalar halen takip ediliyor.
TARTIÞMA ve SONUÇ: Endometriozis olgularý sezaryan skarý ve karýn ön duvarýnda nadir olarak görülmekte olup palpe edilebilen kitle ile birlikte aðrýya yol açar.Cerrahi eksizyon etkin bir tedavi yöntemidir. Nüksü engellemek için en az 1 cmlik cerrahi sýnýrla kitleyi çýkartmak gerekir.Batýn ön duvarýnda ve sezaryan skarýnda kitle þikayeti ile gelen üreme çaðýndaki kadýnlarda endometriozis akýlda tutulmalýdýr.