Sunday, February 9, 2014

Scar Endometrioma

Endometriosis is not an uncommon condition,where the inner linning of the uterus endometrium is implanted inside the abdomen at various sites due to back flow of period blood through the fallopian tube.It causes painful and heavy periods as well as painful sex,painful passage of stool etc.
It can be treated by certain medicines but primarily surgery.The treatment is unsatisfactory at best unless the Lady gets menopause or uterus and ovaries both are removed.
But today I wish to write about something much rarer SCAR EDOMETRIOMA.It is a condition when during any surgery involving uterus endometrium is imbedded in various layers of abdomen leading to tumor or swelling which increases in size prior to the period and during period and the lump is painful as well.It decreases in size after periods.The incidence of scar endometrioma after a caesarean is 0.1 % to0.01 %.The treatment of such a condition is to excise the lump with at least 1 cm of free margin as well to prevent such recurrence of the lump.
Recently I came acoss such patient who had a caesarean delivery about 6 years back and was having a lump at her caesarean scar since then.
My surgeon husband felt strongly that a surgeon rather than Gynaecologist should treat it as in past Gynaecologists have referred such cases to him rather than correct it themselves.But there is nothing so complicated about treating it and any surgeon i.e, Gynaecologist or surgeon who can repair and stitch anterior abdominal wall can operate it,which I did.
The idea of shairing is this fact is both for the Gynaecologists who transfer it to a surgeon and also for the patinet's to know the correct specialist for their treatment.
The dianosis of this condition can be confusing at times being confused with cancers or desmoid tumours ,infected scar etc.It can be confirmed finally with histopathology but prior to that ultrasound and if still confusion persists MRI can be used to come to a preoperative diagnosis.
Also while performing caesarean tissue handling should be kept to minimum( which is correct for any surgery)by the Gynaecologists.Despite careful tissue handling this is still a possibilty but every little bit of surgical technique counts in prevent such non serious but nagging post operative problems.

scar endometrioma

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