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2005, Number 3

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Rev Med Inst Mex Seguro Soc 2005; 43 (3)

Endometriosis in Delayed Scarring of Postpartum Eutocic Episiorrhaphy. Integral Aspects and a Case Report

Hernández VM, Zárate A, Hernández QT, Landero M de OME, Escamilla GG

Language: Spanish
References: 70
Page: 237-242
PDF size: 111.41 Kb.


ABSTRACT

Endometriosis remains a mystery because it has not yet been shown why these cells are viable in the abdominal cavity, although it has been thought that the immune system plays a role in implan-tation outside the intrauterine cavity by abasement in the regulatory capacity of natural killer cells, as well as peripheral and peritoneal immunologic cells. Among methods used to recognize this illness are laparoscopy, laparotomy, ultrasound, antibodies, and the histologic study. It has been observed that surgical scars can present cyclical inflammation and pain when affected with this pathology. We present the case of a patient with a second delivery who arrived at the Gynecology Service due to referring intense pain in the episi-orrhaphy scar as well as superficial dyspareunia. One year after performance of the surgical procedure, pain did not allow the patient was unable to sit normally; in addition, during the last 3 months the area of the cicatrix augmented in volume during menstruation. Under peridural block and with surgical spindle excision, the abnormal tissue was dissected without compli-cations; the surgery showed brittle tissue and with abundant new vascularity. The histologic diagnosis reported vulvar-tissue endometriosis. Was initiate complementary treatment was initiated with gestrinon once a week for 4 weeks, as well as danazol daily for 2 months to avoid possible persistence of endometrial tissue. The scar at present is minimal and is observed along the borders of the surgical union line, without an increase in size nor discomfort on digital pressure. We consider it necessary to assure cleaning of the episiotomy before initiating surgical suturing to diminish presence of endometriosis, despite the fact that incidence of this disturbance is low (0.03%). Advancement in knowledge of the physio-pathology process will permit elimination of the remaining endometrial tissue with new therapeutic strategies, as well as clearing up the mechanism of ectopic implantation of endometrial cells.


REFERENCES

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  2. Zárate A, Villalobos M, Hernández-Valencia M. El enigma de la endometriosis. Rev Fac Med UNAM 1995;38:31-34.

  3. Geist SH. The viability of fragments of menstrual endometrium. Am J Obstet Gynecol 1993;25:751-754.

  4. Keettel WC, Stein RJ. The viability of the cast-off menstrual endometrium. Am J Obstet Gynecol 1951;61: 440-442.

  5. Beyth Y, Yaffe H, Levij S, Sadovsky E. Retrograde seeding of endometrium: a sequela of tubal flushing. Fertil Steril 1975;26:1094-1097.

  6. Koninckx PR, Ide P, Vandenbroucke W, Brosens IA. New aspects of the pathophysiology of endometriosis and associated infertility. J Reprod Med 1980;24:257-260.

  7. Mungyer G, Willemsen P, Rolland R. Cell of the mucous membrane of the female genital tract in culture: a comparative study with regard to the histogenesis of endometriosis. In Vitro Cell Dev Biol 1987;23:111-117.

  8. Hernández GCA, Tlapaco BR, Ramos PC, Velázquez RN, Castro ED, Cérbulo VA. Endometriosis y abatimiento de las características de la respuesta inmunológica

  9. citotóxica. Ginecol Obstet Mex 2003;71:559-574.

  10. Rojas PG, Díaz-Argüello D, De la Rosa AE, Barrosa VG, Kably AA. Endometriosis. Análisis del hallazgo laparoscópico en el Hospital ABC. Ginecol Obstet Mex

  11. 1995;63:401-405.

  12. 10.- Salas-Cisneros S, Paulín-González D. Agenesia cervical con endometriosis secundaria. Tratamiento quirúrgico de una caso. Ginecol Obstet Mex 1996;64:477-480.

  13. Simpson JL, Elias S, Malinak LR, Buttram VC Jr. Heritable aspects of endometriosis. I. Genetic studies. Am J Obstet Gynecol 1980;137:327-331.

  14. Rodriguez-Escudero FJ, Neyro JL, Corcostegui B, Benito JA. Does minimal endometriosis reduce fecundity? Fertil Steril 1988;50:522-524.

  15. Dunphy BC, Kay R, Barratt CLR, Cooke ID. Female age, and the length of involuntary infertility prior to investigation and fertility outcome. Hum Reprod

  16. 1989;4:527-530.

  17. Norwood GE. Sterility and fertility in women with pelvic endometriosis. Clin Obstet Gynecol 1960;3:456-461.

  18. Chauhan M, Barratt CLR, Cooke SMS, Cooke ID. Differences in the fertility of donor insemination recipients-a study to provide prognostic guidelines as

  19. to its success and outcome. Fertil Steril 1989;51:815-819.

  20. Michowitz M, Baratz M, Stavorovsky M. Endometriosis of the umbilicus. Dermatologica 1983;167:326-330.

  21. Wong CFJ, Juárez AA, Villareal PC, Duarte TR, Motta ME. Endometriosis cutánea en cicatriz abdominal, posterior a operación cesárea. Informe de un caso y revisión de la literatura. Ginecol Obstet Mex 1995;63;222-225.

  22. Díaz-Barreiro PG, Niño SA, Castillo GM. Endometriosis en la cicatriz de episiotomía y en vagina. Informe de un caso y revisión de la literatura. Ginecol Obstet Mex 2002;70:281-284.

  23. Schwartz LB, Seifer DB. Diagnostic imaging of adnexal masses: a review. J Reprod Med 1992;37:63-71.

  24. Kauppila A, Telimaa S, Ronnberg L, Vuori J. Placebocontrolled study on serum concentrations of CA-125 before and after treatment of endometriosis with

  25. danazol or high-dose medroxyprogesterone acetate alone or after surgery. Fertil Steril 1988;49:37-41.

  26. Telimaa S, Kauppila A, Ronnberg L, Suikkari AM, Seppala M. Elevated serum level sof endometrial secretory protein PP14 in patients with advanced

  27. endometriosis: suppression by treatment with danazol and high-dose medroxyprogesterone acetate. Am J Obstet Gynecol 1989;161:866-871.

  28. Telimaa S, Puolakka J, Ronnberg L, Kaupilla A. Placebocontrolled comparison of danazol and high-dose medroxyprogesterone acetate in the treatment of endometriosis. Gynecol Endocrinol 1987;1:13-25.

  29. Cervantes VE, García ZHR, Herrera PE, Barrón VJ. Gestrinona en endometriosis pélvica. Evaluación a un año. Ginecol Obstet Mex 1995;63:328-330.

  30. Henzl MR, Corson SL, Moghissi K, Buttram VC, Berqvist C, Jacobson J. Administration of nasal nafarelin as compared with oral danazol for endometriosis: a multicenter double-blind comparative clinical trial. N Engl J Med 1988;318:485-489.

  31. Hull ME, Moghissi KS, Magyar DF, Hayes MF. Comparison of different treatment modalities of endometriosis in infertile women. Fertil Steril 1987;47:40-44.

  32. Redwine DB. Treatment of endometriosis-associated pain. Infertil Reprod Med Clin N Am 1993;3:697- 721.

  33. Guzick DS, Rock JA. A comparison of danazol and conservative surgery for the treatment of infertility due to mild or moderate endometriosis. Fertil Steril

  34. 1983;40:580-584.

  35. Gordts S, Boeckx W, Brosens I. Microsurgery of endometriosis in infertile patients. Fertil Steril 1984;42: 520-525.

  36. Gómez AE, Gorozpe CJI. Endometriosis. Mecanismos potenciales de esterilidad. Esquema inductor en pacientes con endometriosis. Revisión y reflexiones.

  37. Ginecol Obstet Mex 1999;67:58-62.

  38. Nezhat C, Hood J, Winer W, Nexhat F, Crowgey SR, Garrison CP. Videolaseroscopy and laser laparoscopy in gynaecology. Br J Hosp Med 1987;38:219-224.

  39. Brenner G, Wohlagemuth S, Hortfolk V. Scar endometriosis. Gynecol Obstet 1990;170:538-540.

  40. Javert CT. Pahogenesis of endometriosis based on endometrial homeoplasia, direct extension, exfoliation and implanttion, lymphatic and hematogenous metastasis. Cancer 1949;2:399-410.

  41. Zárate A, Villalobos M, Hernández-Valencia M. El enigma de la endometriosis. Rev Fac Med UNAM 1995;38:31-34.

  42. Geist SH. The viability of fragments of menstrual endometrium. Am J Obstet Gynecol 1993;25:751-754.

  43. Keettel WC, Stein RJ. The viability of the cast-off menstrual endometrium. Am J Obstet Gynecol 1951;61: 440-442.

  44. Beyth Y, Yaffe H, Levij S, Sadovsky E. Retrograde seeding of endometrium: a sequela of tubal flushing. Fertil Steril 1975;26:1094-1097.

  45. Koninckx PR, Ide P, Vandenbroucke W, Brosens IA. New aspects of the pathophysiology of endometriosis and associated infertility. J Reprod Med 1980;24:257-260.

  46. Mungyer G, Willemsen P, Rolland R. Cell of the mucous membrane of the female genital tract in culture: a comparative study with regard to the histogenesis of endometriosis. In Vitro Cell Dev Biol 1987;23:111-117.

  47. Hernández GCA, Tlapaco BR, Ramos PC, Velázquez RN, Castro ED, Cérbulo VA. Endometriosis y abatimiento de las características de la respuesta inmunológica citotóxica. Ginecol Obstet Mex 2003;71:559-574.

  48. Rojas PG, Díaz-Argüello D, De la Rosa AE, Barrosa VG, Kably AA. Endometriosis. Análisis del hallazgo laparoscópico en el Hospital ABC. Ginecol Obstet Mex 1995;63:401-405.

  49. Salas-Cisneros S, Paulín-González D. Agenesia cervical con endometriosis secundaria. Tratamiento quirúrgico de una caso. Ginecol Obstet Mex 1996;64:477-480.

  50. Simpson JL, Elias S, Malinak LR, Buttram VC Jr. Heritable aspects of endometriosis. I. Genetic studies. Am J Obstet Gynecol 1980;137:327-331.

  51. Rodriguez-Escudero FJ, Neyro JL, Corcostegui B, Benito JA. Does minimal endometriosis reduce fecundity? Fertil Steril 1988;50:522-524.

  52. Dunphy BC, Kay R, Barratt CLR, Cooke ID. Female age, and the length of involuntary infertility prior to investigation and fertility outcome. Hum Reprod 1989;4:527-530.

  53. Norwood GE. Sterility and fertility in women with pelvic endometriosis. Clin Obstet Gynecol 1960;3:456-461.

  54. Chauhan M, Barratt CLR, Cooke SMS, Cooke ID. Differences in the fertility of donor insemination recipients-a study to provide prognostic guidelines as to its success and outcome. Fertil Steril 1989;51:815-819.

  55. Michowitz M, Baratz M, Stavorovsky M. Endometriosis of the umbilicus. Dermatologica 1983;167:326-330.

  56. Wong CFJ, Juárez AA, Villareal PC, Duarte TR, Motta ME. Endometriosis cutánea en cicatriz abdominal, posterior a operación cesárea. Informe de un caso y revisión de la literatura. Ginecol Obstet Mex 1995;63;222-225.

  57. Díaz-Barreiro PG, Niño SA, Castillo GM. Endometriosis en la cicatriz de episiotomía y en vagina. Informe de un caso y revisión de la literatura. Ginecol Obstet Mex 2002;70:281-284.

  58. Schwartz LB, Seifer DB. Diagnostic imaging of adnexal masses: a review. J Reprod Med 1992;37:63-71.

  59. Kauppila A, Telimaa S, Ronnberg L, Vuori J. Placebocontrolled study on serum concentrations of CA-125 before and after treatment of endometriosis with danazol or high-dose medroxyprogesterone acetate alone or after surgery. Fertil Steril 1988;49:37-41.

  60. Telimaa S, Kauppila A, Ronnberg L, Suikkari AM, Seppala M. Elevated serum level sof endometrial secretory protein PP14 in patients with advanced endometriosis: suppression by treatment with danazol and high-dose medroxyprogesterone acetate. Am J Obstet Gynecol 1989;161:866-871.

  61. Telimaa S, Puolakka J, Ronnberg L, Kaupilla A. Placebocontrolled comparison of danazol and high-dose medroxyprogesterone acetate in the treatment of endometriosis. Gynecol Endocrinol 1987;1:13-25.

  62. Cervantes VE, García ZHR, Herrera PE, Barrón VJ. Gestrinona en endometriosis pélvica. Evaluación a un año. Ginecol Obstet Mex 1995;63:328-330.

  63. Henzl MR, Corson SL, Moghissi K, Buttram VC, Berqvist C, Jacobson J. Administration of nasal nafarelin as compared with oral danazol for endometriosis: a multicenter double-blind comparative clinical trial. N Engl J Med 1988;318:485-489.

  64. Hull ME, Moghissi KS, Magyar DF, Hayes MF. Comparison of different treatment modalities of endometriosis in infertile women. Fertil Steril 1987;47:40-44.

  65. Redwine DB. Treatment of endometriosis-associated pain. Infertil Reprod Med Clin N Am 1993;3:697- 721.

  66. Guzick DS, Rock JA. A comparison of danazol and conservative surgery for the treatment of infertility due to mild or moderate endometriosis. Fertil Steril 1983;40:580-584.

  67. Gordts S, Boeckx W, Brosens I. Microsurgery of endometriosis in infertile patients. Fertil Steril 1984;42: 520-525.

  68. Gómez AE, Gorozpe CJI. Endometriosis. Mecanismos potenciales de esterilidad. Esquema inductor en pacientes con endometriosis. Revisión y reflexiones. Ginecol Obstet Mex 1999;67:58-62.

  69. Nezhat C, Hood J, Winer W, Nexhat F, Crowgey SR, Garrison CP. Videolaseroscopy and laser laparoscopy in gynaecology. Br J Hosp Med 1987;38:219-224.

  70. Brenner G, Wohlagemuth S, Hortfolk V. Scar endometriosis. Gynecol Obstet 1990;170:538-540.




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