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Cited by 30Endometriosis Research and TreatmentGynecological conditions and treatmentsIntestinal and Peritoneal Adhesions

Clinicopathological features of endometriosis in abdominal wall – clinical analysis of 151 cases

Open access
Zhang, J., Liu, X.·2016·Clinical and Experimental Obstetrics & Gynecology
DOI 10.12891/ceog2126.2016
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Abstract

UNLABELLED: Summary OBJECTIVE: To explore the clinicopathological features of abdominal wall endometriosis (AWE). MATERIALS AND METHODS: A retrospective study was made of 151 AWE patients, who were treated at Obstetrics and Gynecology Hospital, Fudan University from 2003 to 2010. RESULTS: Most patients (80.1%) presented with cyclic pain and/or cyclic abdominal masses. The latent period of AWE patients was 31.48 ± 28.27 months (three to 192 months), which was not correlated with factors related to previous cesarean section (CS) (such as age at CS, incision site, gestational week at CS, baby's birth weight, lactation period, postpartum menstruation recovery, choices of contraceptives, etc). The duration of disease was 33.07 ± 28.58 months (two to 168 months), which was negatively correlated with the latent period (r = -0.267, p = 0.043). The pre-operational ultrasonography detection rate was 97.4% (147/151 cases). The lesion size detected by preoperative ultrasonography was significantly smaller than that measured intraoperatively by palpation (21.6 ± 20.7mm vs. 30.21 ± 30.9mm p < 0.05). Moreover, only 26.5% (40/151 cases), in AWE patients the infiltration depth was revealed by preoperative ultrasonography. All patients received surgical treatment. The symptoms were relieved in 93.4% (141/151 cases) patients after surgery. The recurrence rate was 7.3% (11/151 cases) while the average recurrent time was 19.8 ± 15.99 months. The recurrence rate was significantly lower in postoperative medication group than that in non-medication one (p < 0.05). In addition, the morphologic features of AWE lesions also contributed to recurrence. The duration of disease in large scar endometrioma (LSE) group (the diameter of lesions ≥ three cm) was significantly longer than that in small scar endometrioma (SSE) group (the diameter of lesions < three cm), while SSE group had higher recurrence rate (p < 0.05). CONCLUSIONS: The indications of previous CS, factors related to delivery and lactation, have little effect on the exact time of AWE onset. Although ultrasonography is beneficial to preoperative diagnosis of AWE, its accuracy in evaluating lesion size and infiltration depth is limited, which should be interpreted appropriately. The morphologic features of AWE lesions may be correlated with the severity of disease. Surgery is the first-line treatment of AWE and postoperative medication might reduce recurrence.

AI snapshot

Written from the paper’s full text.

TL;DR

This retrospective analysis of 151 abdominal wall endometriosis (AWE) patients at a single Chinese hospital describes clinical presentation, preoperative ultrasound accuracy, surgical outcomes, and recurrence. Surgery relieved symptoms in most patients, postoperative medication was associated with lower recurrence, and lesion morphology (large vs. small scar endometrioma) correlated with disease course and recurrence.

Key findings

  • Most patients (80.1%, 121/151) had cyclic pain and/or cyclic abdominal mass. Preoperative ultrasound detection rate was 97.4% (147/151), but ultrasound underestimated lesion size (21.6 ± 20.7 mm vs. intraoperative 30.21 ± 30.9 mm, p < 0.05) and revealed invasion depth in only 26.5% (40/151).
  • The latent period after cesarean section was 31.48 ± 28.27 months and was not correlated with previous cesarean/delivery/lactation factors. Clinical course was 33.07 ± 28.58 months and was reported as negatively correlated with latent period (abstract: r = -0.267, p = 0.043; results text reports r = 0.267, p = 0.043).
  • All 151 patients underwent surgery; symptoms were relieved in 93.4% (141/151). Recurrence rate was 7.3% (11/151), with average recurrence time 19.8 ± 15.99 months. Postoperative medication was associated with lower recurrence than no medication (3.5% vs. 9.6%, p < 0.05).
  • Large scar endometrioma (LSE, lesion ≥ 3 cm; 101 cases) had a longer clinical course than small scar endometrioma (SSE, lesion < 3 cm; 50 cases) (37.53 vs. 23.68 months, p < 0.05), while SSE had a higher recurrence rate (8/11 recurrences in SSE; p = 0.004 in Table 2).

Methods

  • Retrospective study of 151 AWE patients treated at Obstetrics and Gynecology Hospital, Fudan University from 2003 to 2010; all patients had a history of cesarean section. The text also notes 166 admitted cases and 155 completing follow-up, but the analysis reports 151 cases.
  • Data covered clinical features, ultrasound findings, surgical/pathological findings, treatment, and follow-up (16–97 months). Recurrence was defined as cyclic abdominal wall pain returning to preoperative level or pathologically diagnosed AWE after surgery.
  • Statistical analysis used SPSS 13.0; chi-square test for count data and analysis of variance for measurement data, with p < 0.05 considered significant.

Limitations

  • Stated limitations: Not stated in the paper; there is no dedicated limitations section.
  • Evident from the text: retrospective single-center design; ultrasound invasion depth was recorded in only 40/151 patients (26.5%), limiting assessment of depth accuracy; some reported values are inconsistent (e.g., correlation sign differs between abstract and results; gravidity listed as 31.27 ± 3.88 weeks).
  • Evident from the text: postoperative medication groups were not randomized, so the lower recurrence association may be confounded.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.12891/ceog2126.2016

Cites

7 of 7 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 5 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Most AWE patients presented with cyclic pain and/or cyclic abdominal masses (80.1%).

    “Most patients (80.1%) presented with cyclic pain and/or cyclic abdominal masses.”
    • Also stated in: § Clinical features · plain
      “All patients had a history of CS and among them, 121 (80.1%) cases had periodic abdominal pain, or cyclical lower abdominal mass”
    Quote in the paperNot a substantial claim
  • Findingown data

    The recurrence rate of AWE after surgery was 7.3% (11/151).

    “The recurrence rate was 7.3% (11/151 cases)”
    • Also stated in: § Curative effect and related factors · plain
      “In 151 patients there were 11 cases of recurrence, and the recurrence rate was 7.3%.”
    Quote in the paperSubstantial claim
  • Findingown data

    Clinical course was negatively correlated with latent period (r = -0.267, p = 0.043).

    “which was negatively correlated with the latent period (r = -0.267,p=0.043).”
    • Also stated in: § The incubation period and clinical course · plain
      “The length of clinical course was negatively correlated with the incubation period (r = 0.267, p = 0.043).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Cesarean operation indication was not associated with the occurrence of AWE.

    “Therefore cesarean operation indication is not associated with the occurrence of AWE.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8]

      Not checked in the free run.

  • Findingown data

    The average recurrence time was 19.8 ± 15.99 months.

    “while the average recurrent time was 19.8 ± 15.99 months.”
    • Also stated in: § Curative effect and related factors · plain
      “The average recurrence time was 19.8 ± 15.99 months.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 10
  • Classified as probably not a substantial claim. 3

  • May combine two claims.

    Findingown data

    There was no difference between LSE and SSE groups in invasion depth or perioperative medication usage.

    “The present data showed that there were no difference between LSE and SSE groups in the invasion depth and the medication usage during perioperative time”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Eight AWE patients were diagnosed in routine examination and five during other gynecological operations.

    “Eight patients were diagnosed in routine examination, five patients were diagnosed during undergoing other gynecological operations”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Postpartum breastfeeding, breastfeeding duration, and menstrual recovery time were independent from the incubation period (p > 0.05).

    “Postpartum breastfeeding, breastfeeding duration.and menstrual recovery time were independent from the incubation period (p > 0.05).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Postoperative medication can inhibit ovarian function, reduce estrogen levels, cause atrophy of ectopic endometrium, and thereby inhibit growth and prevent relapse.

    “Postoperative medication can inhibit ovarian function while reducing the level of estrogen, causing atrophy of ectopic endometrium, thereby inhibiting its growth and prevent relapse.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The more delayed the finding of AWE, the more serious the symptoms and the greater the need for surgical treatment.

    “indicating that the more later finding of AWE, the more serious the symptoms were and the need for surgical treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Preoperative medication was not apparently beneficial to relieve symptoms or reduce relapse.

    “preoperative medication were no apparently beneficial to relieve symptoms and reduce relapse.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Diagnosis of AWE can be delayed because symptoms are not typical and lesions need to grow to a certain size to cause clinical symptoms.

    “Because the patients' symptoms are not typical and lesions need to grow to a certain size to cause clinical symptom, the diagnosis AWE can be delayed.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 151 patients at a single hospital are representative of the broader AWE population.

  • Classified as probably not a substantial claim.

    Interpretationown data

    LSE and SSE groups may represent two different subtypes.

    “LSE and SSE groups may represent two different subtypes, which deserve further research.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The 151 patients at a single hospital are representative of the broader AWE population.

  • May combine two claims.

    Premisecitation

    CT and MRI can be used for preoperative evaluation of AWE but have no specified characteristics.

    “CT and MRI can be used for preoperative evaluation, but also have no specified characteristics [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12]

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Recurrence may have no correlation with disease course, but is associated with lesion pathophysiological characteristics such as abnormal expression of progesterone/estrogen receptors, genetic polymorphism, epigenetics, and immune factors.

    “The recurrence may have no correlation with the disease course, but associated with lesion pathophysiological characteristics, such as the abnormal expression of progesterone/estrogen receptors, genetic polymorphism, epigenetics.and immune factors [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14]

      Not checked in the free run.

    • Rests on an assumption: The 151 patients at a single hospital are representative of the broader AWE population.

  • May combine two claims.

    Interpretationcitation

    The occurrence of ectopic endometrium growth may not be specially correlated to operation itself, but may be related to genetics, local environment of wound, endocrine metabolism, and other factors.

    “Thus, the occurrence of ectopic endometrium growth may not specially correlated to operation itself, but may be related to genetics, local environment of wound, endocrine metabolism, and other factors [4].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4]

      Not checked in the free run.

    • Rests on an assumption: The 151 patients at a single hospital are representative of the broader AWE population.
11 of 11

  • The paper relies on this without support.

    The postoperative medication and non-medication groups are comparable in baseline recurrence risk.

    “Recurrence rate of postoperative medication group was significantly lower than untreated group (3.5% vs. 9.6%, p < 0.05)”

  • The paper relies on this without support.

    Intraoperative palpation measurement is an accurate reference standard for lesion size.

    “The lesion size detected by preoperative ultrasonography was significantly smaller than that measured intraoperatively by palpation (21.6 ± 20.7mm vs. 30.21± 30.9mm p < 0.05).”

  • The paper relies on this without support.

    The 151 patients at a single hospital are representative of the broader AWE population.

    “A retrospective study was made of 151 AWE patients, who were treated at Obstetrics and Gynecology Hospital, Fudan University from 2003 to 2010.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Previous reports reviewed cases of CSE diagnosed from 1951 to 2006 and showed that the incidence of CSE was 0.08%; however, a recent (2003 to 2010) study estimated the incidence to be about 2%.

    “Previous reports reviewed cases of CSE diagnosed from 1951 to 2006 and showed that the incidence of CSE was 0.08% [1]; however, a recent (2003 to 2010) study estimated the incidence to be about 2% [9].”

    From Resection and Abdominal Wall Reconstruction for Cesarean Scar Endometriosis (2022) · cites this paper as [9]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Correlation coefficient has opposite signs

    Minor

    The abstract reports a negative correlation with r = -0.267, while the Results section reports r = 0.267 for the same relationship.

  • Muscle-invasion percentage does not match the count

    Minor

    Twenty-five of 151 patients is 16.6% to one decimal place, not 15.6%.

    Reported 15.6 · recomputed 16.556291

  • Percentage for patients with two lesions is incorrect

    Minor

    Nineteen of the 151 patients is 12.6%, not 10.9%.

    Reported 10.9 · recomputed 12.582781

  • Discussion changes lesion measurements from millimeters to centimeters

    Minor

    The discussion gives the ultrasound and operative lesion sizes in centimeters, whereas the Results section gives the same values in millimeters.

  • Follow-up rate does not match the patient counts

    Minor

    The stated 155 completed follow-ups out of 166 admissions gives a follow-up rate of 93.4%, not 91%.

    Reported 91 · recomputed 93.373494

  • Ultrasound lesion-count categories exceed positive examinations

    Minor

    The three categories of lesions inspected by preoperative ultrasound total 150 patients, although the paper says ultrasound had positive findings in only 147 patients.

    Reported 147 · recomputed 150

6 of 6

Cites

Flagged first, then by citations

2 of the 9 references couldn’t be matched to a known paper.

Research works printed but not linked: 7

  1. Francica G., Giardiello C., Angelone G., Cristiano S., Finelli R., Tra- montano G.: "Abdominal wall endometriomas near cesarean deliv- ery scars: sonographic and color Doppler findings in a series of 12 patients". J. Ultrasound Med., 2003, 22, 1041.
  2. Zhao X.Y., Lang J.H., Leng J.H., Liu F.Z., Li H.J., Sun D.W., Zhu L.: "Analysis of abdominal wall endometriosis clinical features and re- lated factors of recurrence". Chinese J. Obstet. Gynecol., 2004, 39, 97.
  3. Wivedi A.J., Agrawal S.N., Silva Y.J.: "Abdominal wall endometri- omas". Dig Dis Sci., 2002, 47, 456.
  4. Hui X.: "Clinical analysis of 60 cases of operation incision en- dometriosis". Modern Diagnosis and Treatment (China), 2005, 3, 148.
  5. Cheng N.H., Zhu L., Lang J.H., Liu Z.F., Sun D.W., Leng J.H.: "Clinical analysis of 101 cases of abdominal wall endometriomas". Reproductive Medicine (China), 2007, 16, 82.
  6. Liang H., Zhou L.F., Wang B.S., Zhong Y.: "Analysis on indications and associated influence factors of cesarean section in Shanghai local hospitals". Chinese Public Health, 2006, 22, 22.
  7. Hao Y.D., Wang L.B., Sun J.L., Shen L.L., Song H.X.: "The expres- sion of estrogen receptor and progesterone receptor in the eutopic and ectopic endometrium of abdominal wall endometriosis". Chi- nese J. of Clinicians, 2009, 3, 487.

Cited by

Sorted by citations

Related

Authors
Zhang, J., & Liu, X.
Affiliations
Fudan University (CN)
Corresponding author
Liu, X.
ORCID
Liu, X.
Venue
Clinical and Experimental Obstetrics & Gynecology
Publisher
IMR Press
Published
2016-06-10
Volume
43
Issue
3
Pages
379-383
ISSN
0390-6663 (ISSN-L)
DOI
10.12891/ceog2126.2016
OpenAlex
W2475351232
Semantic Scholar
c13c7a3c38eaa4d9b46c8c709f7ddb58a52f0ed5
Cited by
30
References
9
Citations by year
2026: 3 · 2025: 3 · 2024: 2 · 2023: 2 · 2022: 5 · 2021: 5 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 4 · 2016: 1
FWCI
3.99
Type
journal article
Language
en
Open access
Locations
  • Clinical and Experimental Obstetrics & Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Natural Science Foundation of China (81070470, 81370695)
  • Fudan University
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
  • Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
Keywords
abdominal wall endometriosis, endometrioma, clinicopathological features, cyclic abdominal pain, latency, preoperative ultrasound, surgical treatment, recurrence, postoperative medication, cesarean section, disease duration, lesion size, infiltration depth, postoperative complications, postoperative adhesions, postoperative pain
MeSH terms
Adult, Breast Feeding, Cesarean Section, Cicatrix, Endometriosis, Female, Premature Rupture of Fetal Membranes, Gestational Age, Humans, Middle Aged, Pregnancy, Recurrence, Retrospective Studies, Time Factors, Ultrasonography, Abdominal Wall, Young Adult

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