Abdominal Wall Endometriosis as Endometrioma-Cutaneous Fistula: A Case Report

Oluyemisi A. Adeyemi¹, Creighton L. Edwards¹, Thomas M. Wheeler², Shannon M. Hawkins^1*

¹Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, USA.
²Department of Pathology & Immunology, Baylor College of Medicine, Houston, USA.

DOI: 10.4236/ojog.2014.414116                

Abstract

Endometriosis outside the pelvic cavity is rare, but its most common extra-pelvic location is the abdominal wall, occurring most frequently after cesarean delivery. Fistula tracks through these lesions in the abdominal wall to the uterus are rare. However, a fistula between abdominal wall endometriosis to an endometrioma has not been reported. A 46-year-old multigravid woman presented with complaint of cyclical pain and bleeding from her cesarean delivery scar and pelvic pressure. Computed tomography revealed a complex, 16-cm left adnexal mass. Intraoperatively, a fistulous tract connecting a large endometrioma in the abdominal-pelvic cavity to the skin was noted and wide local excision of this track was performed in conjunction with aggressive surgical management of endometriosis throughout the pelvis. Pathologic analysis of the resected specimen confirmed the diagnosis. Although rare, endometrioma-cutaneous fistula should be included in the differential diagnosis of suspected abdominal wall endometriosis with concurrent adnexal mass for appropriate surgical planning.

Keywords

Endometrioma, Fistula, Abdominal Wall Endometriosis, Surgical Management

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Giannella, L., La Marca, A., Ternelli, G. and Menozzi, G. (2010) Rectus Abdominis Muscle Endometriosis: Case Report and Review of the Literature. Journal of Obstetrics and Gynaecology Research, 36, 902-906. http://dx.doi.org/10.1111/j.1447-0756.2010.01236.x
[2]	Hensen, J.H., Van Breda Vriesman, A.C. and Puylaert, J.B. (2006) Abdominal Wall Endometriosis: Clinical Presentation and Imaging Features with Emphasis on Sonography. American Journal of Roentgenology, 186, 616-620. http://dx.doi.org/10.2214/AJR.04.1619
[3]	Taff, L. and Jones, S. (2002) Cesarean Scar Endometriosis. A Report of Two Cases. The Journal of Reproductive Medicine, 47, 50-52.
[4]	Dragoumis, K., Mikos, T., Zafrakas, M., et al. (2004) Endometriotic Uterocutaneous Fistula after Cesarean Section. A Case Report. Gynecologic and Obstetric Investigation, 57, 90-92. http://dx.doi.org/10.1159/000075384
[5]	Dwivedi, A.J., Agrawal, S.N. and Silva, Y.J. (2002) Abdominal Wall Endometriomas. Digestive Diseases and Sciences, 47, 456-461. http://dx.doi.org/10.1023/A:1013711314870
[6]	Honore, G.M. (1999) Extrapelvic Endometriosis. Clinical Obstetrics and Gynecology, 42, 699-711. http://dx.doi.org/10.1097/00003081-199909000-00021
[7]	Patterson, G.K. and Winburn, G.B. (1999) Abdominal Wall Endometriomas: Report of Eight Cases. The American Journal of Surgery, 65, 36-39.
[8]	Nissotakis, C., Zouros, E., Revelos, K., et al. (2010) Abdominal Wall Endometrioma: A Case Report and Review of the Literature. AORN Journal, 91, 730-742. http://dx.doi.org/10.1016/j.aorn.2010.01.014
[9]	Gupta, S.K., Shukla, V.K., Varma, D.N., et al. (1993) Uterocutaneous Fistula. Postgraduate Medical Journal, 69, 822-823. http://dx.doi.org/10.1136/pgmj.69.816.822
[10]	Thubert, T., Denoiseux, C., Faivre, E., et al. (2012) Combined Conservative Surgical and Medical Treatment of a Uterocutaneous Fistula. Journal of Minimally Invasive Gynecology, 19, 244-247. http://dx.doi.org/10.1016/j.jmig.2011.10.010
[11]	Seyhan, A., Ata, B., Sidal, B., et al. (2008) Medical Treatment of Uterocutaneous Fistula with Gonadotropin-Releasing Hormone Agonist Administration. Obstetrics Gynecology, 111, 526-528. http://dx.doi.org/10.1097/01.AOG.0000281670.94265.5c
[12]	Shukla, D., Pandey, S., Pandey, L.K., et al. (2006) Repair of Uterocutaneous Fistula. Obstetrics Gynecology, 108, 732-733. http://dx.doi.org/10.1097/01.AOG.0000188067.74163.40
[13]	Sonmezer, M., Sahincioglu, O., Cetinkaya, E., et al. (2009) Uterocutaneous Fistula after Surgical Treatment of an Incomplete Abortion: Methylene Blue Test to Verify the Diagnosis. Archives of Gynecology and Obstetrics, 279, 225- 227. http://dx.doi.org/10.1007/s00404-008-0683-7
[14]	Mintz, N. and Gaines, J.A. (1951) Endometriosis in a Laparotomy Scar; Report of a Case with Utero-Abdominal Fistula. Journal of the Mount Sinai Hospital, New York, 17, 613-617