Scar Endometriosis Developing After an Umbilical Hernia Repair
Scar Endometriosis Developing After an Umbilical Hernia Repair
A 44-year-old female was initially evaluated for a 3-cm umbilical hernia, which developed after a laparoscopic myomectomy performed seven years prior. The umbilical hernia was repaired using a synthetic mesh. Eight months after the umbilical hernia repair, the patient returned with chronic pain in a 3-cm raised mass originating from the umbilical hernia repair incision. The mass and mesh were surgically removed. The umbilical fascial defect was repaired with a primary fascia-to-fascia closure and the umbilicus was reconstructed from adjacent skin. The mass was found histologically to be endometriosis and fascial scarring with a foreign body reaction to synthetic mesh. Umbilical endometriosis developed either from peritoneal endometrial seeding from a laparoscopic myomectomy or from metaplasia of multipotential cells, which developed into endometriosis due to inflammatory stimulation by the synthetic mesh. Synthetic mesh probably should be avoided in the surgical repair of a laparoscopically caused umbilical hernia in a premenopausal female especially if there is a history of pelvic endometriosis.
Endometriosis is present in 7 to 10% of women and is a difficult disease to treat during the reproductive years. Endometriosis is defined as the presence of ectopic functional endometrial tissue outside of the uterine cavity. The most common locations are in the pelvis involving the ovaries, fallopian tubes, posterior cul-de-sac, uterine ligaments, rectovaginal septum and surrounding pelvic peritoneum. Endometriosis has been described in almost every area of the female body. The most common extrapelvic appearance of endometriosis occurs in scars following a variety of obstetric and gynecologic surgery. Umbilical endometriosis has been reported spontaneously or after various surgical procedures. We are reporting the unusual development of umbilical endometriosis after an umbilical hernia repair with mesh.
A 44-year-old female was initially evaluated for a 3-cm umbilical hernia, which developed after a laparoscopic myomectomy performed seven years prior. The umbilical hernia was repaired using a synthetic mesh. Eight months after the umbilical hernia repair, the patient returned with chronic pain in a 3-cm raised mass originating from the umbilical hernia repair incision. The mass and mesh were surgically removed. The umbilical fascial defect was repaired with a primary fascia-to-fascia closure and the umbilicus was reconstructed from adjacent skin. The mass was found histologically to be endometriosis and fascial scarring with a foreign body reaction to synthetic mesh. Umbilical endometriosis developed either from peritoneal endometrial seeding from a laparoscopic myomectomy or from metaplasia of multipotential cells, which developed into endometriosis due to inflammatory stimulation by the synthetic mesh. Synthetic mesh probably should be avoided in the surgical repair of a laparoscopically caused umbilical hernia in a premenopausal female especially if there is a history of pelvic endometriosis.
Endometriosis is present in 7 to 10% of women and is a difficult disease to treat during the reproductive years. Endometriosis is defined as the presence of ectopic functional endometrial tissue outside of the uterine cavity. The most common locations are in the pelvis involving the ovaries, fallopian tubes, posterior cul-de-sac, uterine ligaments, rectovaginal septum and surrounding pelvic peritoneum. Endometriosis has been described in almost every area of the female body. The most common extrapelvic appearance of endometriosis occurs in scars following a variety of obstetric and gynecologic surgery. Umbilical endometriosis has been reported spontaneously or after various surgical procedures. We are reporting the unusual development of umbilical endometriosis after an umbilical hernia repair with mesh.