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Re: Incisional Endometriosis/underappreciatedFrom: Braun, R. Daniel (rbraun@iupui.edu)Sat Jul 22 14:00:42 2000
Those are all true statements for General surgeons as a rule. Most all OBGYN's know that a mass appearing in a C/S scar within 2-6 months post C/S is endometriosis untill proved otherwise. If it isn't excised wide enough, it will persist. Sometimes fascia must be removed and grafts sutured into place to repair it. DAn -----Original Message----- From: ryantiques@prodigy.net To: Multiple recipients of list OB-GYN-L Sent: 7/21/00 5:05 PM Subject: Re: Incisional Endometriosis/underappreciated
At Fri, 21 Jul 2000, Paul Prior MD wrote:
> Well thank goodness for your basic understanding in your residency. I'm sure my OB/GYN isn't worth a nickel??? Treatment may be simple but how would any OB/GYN Dx incisional endo with a laparoscopy (the only sure way to Dx endo) when the trochar/scope passes the tissue into the cavity? And I gather that simple treatment to cut it out is perfectly clear, in your eyes, that can microscopically detect implants. X-ray vision must be a real bonus in your profession. As far as "incisional endometriosis" some get it because there is endometrial tissue from the uterus at c-section that speads outside the uterus and reacts to the hormones in this particular person. Maybe my not worth a nickel OB/Gyn should have cleaned up a little better??? This is where I got the info on this underappreaciated disease. I'm sure the Journal of American College of Surgeons should be worth a little more than five cents. Rare but there: endometriosis after C-section NEW YORK, Apr 13 (Reuters Health) -- In rare cases, women who have had a cesarean section may end up with endometriosis in their surgical scar tissue, sometimes years after the operation, according to a report. Endometriosis is a condition in which bits of the lining of the uterus end up in parts of the body they shouldn't be. The misplaced tissue can then wax and wane with a woman's monthly cycle, causing bleeding, irritation and other health problems. Many general surgeons fail to properly diagnose endometriosis in surgical scars (known as incisional endometriosis), according to a report in the April issue of the Journal of the American College of Surgeons. Drs. Raminder Nirula and Gregory C. Greaney, from Santa Barbara Cottage Hospital in California, reviewed the cases of 10 general surgery patients who were diagnosed with incisional endometriosis between January 1990 and December 1998. The disease often manifests as a slow-growing, painful lump at the edge of a surgical scar. Two out of 10 women reported that the lump changed characteristics with their menstrual cycle. The condition was correctly diagnosed in only two cases, the researchers report. Often the lump was initially misdiagnosed as a cyst, incision-related hernia, and in one case, breast cancer that had spread from another part of the body. The women ranged in age from 27 to 41 and experienced symptoms anywhere from 3 months to 10 years. The symptoms began from 1 to 7 years after the cesarean. With the proper diagnosis, the growths, which were an average of 3 centimeters (or just over 1 inch) in size, were surgically removed. The study is the "largest series in the general surgery literature to date, which underscores our underappreciation of this disease," the authors write. SOURCE: Journal of the American College of Surgeons 2000;190:404-407. Rare Endo
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