We present the case of a 42-year-old woman who had undergone laparoscopic hysterectomy for uterine myoma three years prior to diagnosis with trocar site endometriosis. The patient was observed to suffer endometrial implant exclusively at the suprapubic trocar site. This case demonstrated that trocar site endometriosis can occur, even in a patient without a uterus and without previous endometriosis. The etiopathogenesis of this condition was likely attributed to the dissemination of endometrial tissue during laparoscopic surgery, resulting in subsequent microscopic endometriosis cell implantation in the trocar site.Keywords: Endometriosis; Laparoscopy; Implantation Received: 2011.12.19. Revised: 2012 Th is is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright © 2012. Korean Society of Obstetrics and GynecologyEndometriosis is a condition whereby functional endometrial tissue is present outside the uterine cavity. The disease commonly affects the pelvis with the most common locations being the ovaries, urine ligaments, rectovaginal septum and peritoneum. Unusual endometriosis outside the pelvis has been reported to include the bladder, intestines, appendix, hernia sacs, lungs, kidneys and other extremities. It well known that endometriosis may migrate and implant in various anatomic locations including surgical scars [1]. Herein, we report the rare case of a patient who had undergone a laparoscopic hysterectomy for uterine myoma three years prior to a diagnosis of trocar site endometriosis.
Case ReportA 42 year old woman presented an approximately 3 cm sized mass in the suprapubic region at the site of trocar insertion, accompanied by cyclic pain which had commenced eight months prior to her visit. The patient had undergone two Cesarean sections, ten and twelve years prior to her visit, as well as a laparoscopic subtotal hysterectomy which was applied at a private clinic in order to treat a large uterine myoma three years prior to her visit. According to the private clinic, she did not report pelvic pain, dysmenorrhea or dyspareunia prior to the hysterectomy. And besides the uterine myoma, no other abnormal operative fi ndings were observed during the hysterectomy. Our physical examination revealed an approximately 5 cm sized, non-tender mass, accompanied with slight swelling, located in the suprapubic region just beneath the suprapubic trocar site scar. Ultrasonography revealed a 5.5 × 2.2 cm, oval-shaped, hypoechoic mass in the abdominal wall of the suprapubic region. No abnormal findings were observed in the pelvis or ovaries (Fig. 1). Routine clinical laboratory test results were all within normal limits except for CA-125, which was slightly above normal range at 45.4 IU/mL. Based on these findings and symptoms, granulomas due to surgical wounds or CASE REP...