Medical Articles

Abdominal Pain

History

  • 29 year old female
  • Right iliac fossa pain
    • 6 year history
    • Associated irritable bowel symptoms
    • Symptoms worse peri-menstrual
    • Positional element
  • Surgical history
    • Caesarian section 6 years ago

Clinical

  • General examination normal
  • Abdominal examination unremarkable except for RIF pain worse over the lateral aspect of her C/S scar.

Investigations

  • Colonoscopy: Normal
  • Sonar: RIF abdominal wall haematoma 3.6x4.7x2 in relation to the rectus muscle in the right lateral aspect of the C/S scar.
  • Bloods
    • CRP - Normal
    • TSH - Normal
    • IgE - Normal

Procedure

  • Sonar guided resection of lesion
  • Histology: Endometriosis

Abdominal Wall Endometriosis

  • Definition: Endometrial tissue superficial to the peritonium
  • Pathophysiology: Iatrogenic inoculation of the endometrium into a surgical wound
  • Usually after C/S (esp. mid trimester) but can be spontaneous
  • High association with preexisting endometriosis
  • Differential: Hernia, Soft tissue tumour, haematoma, suture granuloma.

Presentation

  • Mean age: 32
  • Past history:
    • C/S – 58%
    • Hysterectomy – 11%
    • 3.6 year mean between index surgery and presentation
  • Clinical
    • Mass – 96%
    • Pain – 84%
    • Cyclic symptoms – 57%

Investigation

  • FNA
  • Imaging:
    • U/S
    • CT
    • MRI
    • Doppler

Complications

  • Multiple lesions
  • Incomplete resection with recurrence (4.3%)
  • Malignant transformation (Clear cell carcinoma)