Endometriose de cicatriz cirúrgica: estudo retrospectivo de 25 anos

Abstract

Introduction: The endometriosis is described by the presence of the endometric woven glandular functional outside the uterus. The most common location is the pelvis, it can also rarely be found in other locations such as surgical scars. Objective: Identify the incidenceand possible endometriosis fisiopathology of scar endometriosis. Methodology: a retrospective study was perfomed from the dossier of 72 women with anatomopathologic diagnosis of endometriosis of surgical scar within the period of May 1978 to December 2003. Results: the incidence of endometriosis after caesarean section was 0,2% and afterephisiotomy 0,06 %. The womens age, when diagnosed, ranged from 16 to 48 years old, ( mean = 30,8 years old). The wound location varied according to the previous surgery: 46 caesarean section, one hysterectomy and one in abdominal surgery (48 wounds in theabdominal wall); 19 ephisiotomy, one was relapse and two pelvic floor surgeries (22 pelvic wounds); two women with no previous ginecological surgery (a belly scar wound and in the posterior vagina wall). Pain was the most frequent symptom (80 %), followed by a node (79%) and in more than 40% the pain and node suffered modification with the periodtime. Other complaints less frequent were: dyspareunia, secondary infertility, pelvic pain, dysmenorrhea, scar secretion, menorrhagia pain when evacuating. The mean time observed between the surgery and the beginning of the symptoms was of 3,7 years. The average sizeof the endometriomas was of 3,07cm. The diagnoses based on clinic valuation was correct in 71% of the cases. The choice of treatment in all the cases was the surgical excision. In only one incident there was relapse and new intervention. Conclusion: Scar endometriosisis a rare situation, being originated, mostly after incision of a gravid uterus, with an easy to make a diagnosis and treatment.