TÍTULO

SCAR ENDOMETRIOMA IN A PATIENT WITH BLADDER EXSTROPHY: CASE REPORT

INTRODUÇÃO

Although endometriosis occurs most frequently in the intrapelvic organs, many cases of extrapelvic endometriosis have been reported. Endometriosis in a surgical scar is rare, and its diagnosis can be confused with other lump lesions.
The most frequent antecedent surgical procedure among patients with scar endometriosis is a Cesarean section2. It was found just one previous report of endometriosis associated with ectopia vesica in scientific usual searched language.
The purpose of this report is to provide a new case for helping clarification of the association between bladder exstrophy and endometriosis, which could also help to lend evidence to the pathogenesis of bladder endometriosis.

RELATO DE CASO

A 32-year-old woman, who underwent surgery for bladder exstrophy in her neonatal period was followed up in Recife, Pernambuco – Brazil for 25 years. She presented several urinary tract infections that were treated. In 2011 she was managed by her gynecologist for endometriosis. Two years ago she moved for Australia and has been followed-up by urologist. One week ago she was aware of a painful induration at the operative scar located in her lower aspect of her abdominal wall scar. A pelvic ultrasound scan revealed a subcutaneous solid lesion demonstrating mild internal vascularity in the lower anterior abdominal wall deep to the surgical scar and 6 cm inferior to the umbilicus. This image was interpreted as endometrioma (Fig. 1). The patient has been treated as carrier of endometriosis as she has had a past history of this condition since 2011.

DISCUSSÃO

Endometriosis that affects up to 22% of all women, about 25% of patients presenting with subfertility and up to 45% of women with pelvic pain5. Cesarian section and hysterectomy are associated with almost 70% of the cases2.
Endometriosis has been described in almost all body cavities and organs, including the central nervous system, lung, small and large bowel, gallbladder, kidney, extremities, perineum, and abdominal wall. Among these sites, the presence of ectopic endometrial tissue within the abdominal wall is uncommon (approximately 2% of the endometriosis cases)2. Of these some are located in the scars including cesarean section and acute appendicitis. However, there are few reports of this entity subsequent to surgical management for bladder extrophy1.
Endometriosis occurring in the bladder is rare, affecting approximately 0.2% to 0.6% of all patients with endometriosis6-10. The etiology for bladder endometriosis, and pathogenesis remain highly controversial, bec

PALAVRAS CHAVE

Bladder exstrophy; Endometrioma; Scar endometriosis; Brazil

Área

CIRURGIA PEDIÁTRICA