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Cited by 7Endometriosis Research and TreatmentMinimally Invasive Surgical TechniquesGynecological conditions and treatments

Laparoscopic umbilical trocar port site endometriosis: A case report

Open access
Ao, Xue, Xiong, Wei, Tan, Shi-Qiao·2020·World Journal of Clinical Cases
DOI 10.12998/wjcc.v8.i8.1532PMC PMC7190959
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Abstract

BACKGROUND: Abdominal wall endometriosis can occur secondary to gynecological and obstetric pelvic laparotomy; however, this is a rare clinical event. There are few cases of endometriosis involving the incision site of a laparoscopic surgery, especially for those of the endometrial nodule at the umbilical trocar port site where the camera is placed. CASE SUMMARY: We describe the case of a 37-year-old woman who presented with a 2-year history of a tough swelling below the umbilicus, which presented periodical pain during menstruation. The patient had undergone laparoscopic ovarian cystectomy 4 years prior, and we theorized that the umbilical nodule was a complication of that laparoscopic surgery. Histological analysis confirmed the diagnosis of abdominal umbilical scar endometriosis secondary to previous laparoscopic surgery. Surgical removal of the nodule followed by three cycles of leuprorelin was curative. CONCLUSION: Abdominal mass and pain in women of childbearing age with a previous history of pelvic surgery should support consideration of endometriosis at the surgical site.

AI snapshot

Written from the paper’s full text.

TL;DR

This case report describes a 37-year-old woman with umbilical trocar port-site endometriosis four years after laparoscopic ovarian cystectomy, confirmed histologically and treated by surgical excision plus three cycles of leuprorelin. The authors conclude that abdominal mass and pain in women of childbearing age with prior pelvic surgery should raise suspicion for abdominal wall endometriosis.

Key findings

  • A 37-year-old woman presented with a slow-growing umbilical nodule at the lower edge of a previous laparoscopic cannula site; it had increased from 0.5 cm to approximately 1.5 cm in diameter and caused periodic pain during menstruation.
  • Fine needle biopsy and immunohistochemistry confirmed umbilical endometriosis; markers included positive estrogen receptor, progesterone receptor, and p63 in infiltrated dermal glands, with progesterone receptor and CD10 in periglandular interstitium, and Ki67 about 10% positive.
  • The nodule was surgically removed and leuprorelin was given for three cycles; intraoperative and postoperative histology confirmed umbilical endometriosis, and the wound recovered well without recurrence to date.
  • The authors’ literature review reports 71 total cases of laparoscopic incision endometriosis in English or Chinese (32 English, 39 Chinese); they also cite AWE symptoms of abdominal wall mass in 82%-96%, pain in 41%-87%, periodic symptoms in only 57%, and asymptomatic cases in 3.08% (2/65).

Methods

  • Single case report from the Dermatology Department of West China Hospital, Sichuan University, Chengdu, China, dated March 29, 2019, with a review of published literature.
  • Diagnostic evaluation included physical examination, fine needle aspiration biopsy with immunohistochemistry, and transvaginal Doppler; no superficial ultrasound of the abdominal wall was performed because the nodules were visible by naked eye.
  • Treatment was surgical excision followed by three cycles of leuprorelin, with intraoperative and postoperative histological confirmation.

Limitations

  • The paper states that laparoscopic incision endometriosis is rare, that few cases have been reported, and that prospective studies are required to increase the quality of existing literature.
  • The paper states there is no gold standard for preoperative diagnosis of abdominal wall endometriosis.
  • Evident from the text: this is a single case without a control group, and the duration of follow-up after treatment is not specified beyond “to date.”

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

Integrity signals

Registry

Crossref · 10.12998/wjcc.v8.i8.1532

Cites

16 of 16 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 22 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    Surgical removal of the nodule followed by three cycles of leuprorelin was curative.

    “Surgical removal of the nodule followed by three cycles of leuprorelin was curative.”
    Quote in the paperSubstantial claim
  • Findingown data

    Fine needle biopsy of the umbilical nodule confirmed the diagnosis of umbilical endometriosis.

    “Fine needle biopsy of the umbilical nodule confirmed the diagnosis of umbilical endometriosis.”
    Quote in the paperSubstantial claim
  • Premisecitation

    In a study by Alborzi et al, laparoscopic exploration after resection of abdominal wall mass in 30 AWE patients found that 28 (93.3%) patients had pelvic endometriosis.

    “However, in a study conducted by Alborzi et al[14], who performed laparoscopic exploration after resection of abdominal wall mass in 30 AWE patients, it was found that 28 (93.3%) patients had pelvic endometriosis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] source

      Not checked in the free run.

  • Premisecitation

    Surgical excision of normal tissue 5-10 mm away from the edge of the lesion is required to prevent recurrence.

    “It is widely accepted that surgical excision is the most appropriate approach, and surgical excision of normal tissue 5-10 mm away from the edge of the lesion is required to prevent recurrence, according to the literature[3,5].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [3] source

      Not checked in the free run.

    • cites [5] Akbarzadeh-Jahromi M, Motavas M, Fazelzadeh A. Recurrent abdominal wall endometriosis at the trocar site of laparoscopy: A rare case. Int J Reprod Biomed (Yazd) 2018; 16: 653-656 source

      Not checked in the free run.

  • Interpretationcitation

    Our case report is likely to support the conclusion that AWE patients have a high rate of pelvic endometriosis.

    “Our case report is likely to support this conclusion.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 15
  • May combine two claims. 19
  • The quote only partly states this claim. 1

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

    Findingcitation

    The appearance of the umbilical nodules in our case was consistent with the description by Anand et al.

    “Anand et al[9] described the appearance of ectopic umbilical scar nodules being usually above the incision, with brown skin changes on the surface of the nodules, consistent with the appearance in our case (Figure 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Immunohistochemical markers estrogen receptor, progesterone receptor, and p63 were positively expressed in infiltrated glands of the dermis; progesterone receptor and CD10 were expressed in periglandular interstitial space; Ki67 was about 10% positive.

    “Positive expression of the immunohistochemical markers’ estrogen receptor, progesterone receptor, and p63 was found in the infiltrated glands of the dermis; in addition, progesterone receptor and cluster of differentiation 10 were expressed in the periglandular interstitial space. Ki67 was about 10% positive in the gland and interstitium.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The wound recovered well after operation, without any recurrence to date.

    “Both intraoperative and postoperative histological analyses confirmed umbilical endometriosis (Figure 2), and the wound recovered well after operation, without any recurrence to date.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    In our patient, incisional endometriosis occurred in the umbilical cannula incision, which was not the cannula incision from which the specimen was taken out.

    “In our patient, incisional endometriosis occurred in the umbilical cannula incision, which was not the cannula incision from which the specimen was taken out of.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Incisional endometriosis after laparoscopy, if it occurs, is usually seen in the cannula incision from which the specimen was collected.

  • May combine two claims.

    Findingnone given

    Umbilical nodules appeared at the incision site of the original laparoscopic cannula at the lower edge of the umbilicus about 4 years prior, gradually increased from 0.5 cm to approximately 1.5 cm in diameter, and were accompanied by pain during menstruation.

    “Umbilical nodules appeared at the incision site of the original laparoscopic cannula at the lower edge of the umbilicus about 4 years prior, which had gradually increased from 0.5 cm to approximately 1.5 cm in diameter and were accompanied by pain during menstruation.”
    Quote in the paperSubstantial claim

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

    Findingown data

    According to our literature review, the total number of cases of laparoscopic incision endometriosis reported in either English or Chinese is 71 to date, including 32 in English and 39 in Chinese.

    “However, according to our literature review, the total number of cases reported in either English or Chinese is 71 to date, including 32 cases in English and 39 cases in Chinese.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Physical examination revealed three brown hard nodules at the umbilical incision, maximum diameter about 1.5 cm, with clear boundaries and no redness or ulceration.

    “At the incision of the original laparoscopic cannula at the lower edge of the umbilicus, three brown hard nodules of different sizes were detected, with the maximum diameter of about 1.5 cm. No redness or ulceration was found on the surface of the nodules (Figure 1). The boundary between the nodules and surrounding tissues was clear.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    The patient was a 37-year-old woman with a slow-growing nodule under the skin of the umbilical surgical scar, causing periodic pain during menstruation.

    “A 37-year-old woman found a slow-growing nodule under the skin of the surgical scar on the umbilicus which caused periodic pain and presented to the Dermatology Department of West China Hospital, Sichuan University (Chengdu, China) on March 29, 2019 for treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Both intraoperative and postoperative histological analyses confirmed umbilical endometriosis.

    “Both intraoperative and postoperative histological analyses confirmed umbilical endometriosis (Figure 2), and the wound recovered well after operation, without any recurrence to date.”
    Quote in the paperSubstantial claim

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

    Findingown data

    The patient had undergone laparoscopic ovarian cyst removal and bilateral salpingoplasty 6 years prior.

    “The patient had undergone laparoscopic ovarian cyst removal and bilateral salpingoplasty at the Department of Reproductive Endocrinology of our hospital 6 years prior.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Transvaginal Doppler showed uneven endometrial echo with slightly strong echo and cysts about 1.5 to 2.9 cm on both ovaries.

    “Transvaginal Doppler showed that the endometrial echo was uneven, with a slightly strong echo (endometrial polyp could not be excluded). A cyst about 1.5 to 2.9 cm in diameter was present on both ovaries (chocolate cyst of the ovary is likely).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    When taking out tissue containing endometrial cells, the abdominal incision is most likely to contact endometrial cells.

    “When taking out the tissue containing endometrial cells, the abdominal incision is most likely to contact endometrial cells.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Oral contraceptives and progesterone can attenuate symptoms only slightly but cannot eliminate the lesion.

    “Oral contraceptives and progesterone can attenuate symptoms only slightly but cannot eliminate the lesion[3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    We suspect that gloves or instruments contaminated with endometrial cells were responsible for the endometrial cells or debris present at the abdominal incision closed by suture.

    “We suspect that gloves or instruments contaminated with endometrial cells were responsible for the endometrial cells or debris present at the abdominal incision closed (by suture).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Abdominal wall endometriosis (AWE) can occur after gynecological and obstetric pelvic surgery, with approximately 57% of cases developing secondary to cesarean section.

    “AWE can be spontaneous, but it can also occur after gynecological and obstetric pelvic surgery, with approximately 57% of cases developing secondary to cesarean section[3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

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

    Premisecitation

    Most scholars agree that the etiology of scar endometriosis is endometrial cell planting during surgical treatment.

    “Most scholars agree that the etiology of scar endometriosis is endometrial cell planting during surgical treatment[1,5].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] source

      Not checked in the free run.

    • cites [5] Akbarzadeh-Jahromi M, Motavas M, Fazelzadeh A. Recurrent abdominal wall endometriosis at the trocar site of laparoscopy: A rare case. Int J Reprod Biomed (Yazd) 2018; 16: 653-656 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The umbilical cannula incision is only used to place the laparoscopic camera, so the chance of contact with endometrial cells is small.

    “This incision is only used to place the laparoscopic camera, so the chance of contact with endometrial cells is small.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Only 57% of patients report periodic symptoms, and 3.08% (2/65) are asymptomatic.

    “Only 57% of patients report periodic symptoms[7], and 3.08% (2/65) are asymptomatic[8].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [7] source

      Not checked in the free run.

    • cites [8] source

      Not checked in the free run.

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

    Premisecitation

    In a study by Horton et al reviewing 29 articles, the average age of patients was 31.4 years (95% CI 29.1-33.8) and the average time of symptom onset was 3.6 years (95% CI 2.5-4.8).

    “In a study by Horton et al[7] that reviewed 29 articles, the average age of patients was 31.4 years (95% confidence interval: 29.1-33.8 years) and the average time of symptom onset was 3.6 years (95% confidence interval: 2.5-4.8 years)[7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] source

      Not checked in the free run.

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

    Premisecitation

    Endometriosis occurs mostly in pelvic organs and is rarely detected in extrapelvic locations.

    “Endometriosis occurs mostly in pelvic organs and is rarely detected in extrapelvic locations, such as the abdominal wall, central nervous system, lungs, kidneys, ureters, limbs, gallbladder, nasal cavity, brain, and distant skin[1,2].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] source

      Not checked in the free run.

    • cites [2] source

      Not checked in the free run.

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

    Premisecitation

    Abdominal wall mass (82%-96%) and pain (41%-87%) are the most common symptoms of AWE.

    “Abdominal wall mass (82%-96%) and pain (41%-87%) are the most common symptoms of AWE[6,7].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [6] source

      Not checked in the free run.

    • cites [7] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In extensive lesions, CT or MRI can assess the location and size of AWE more accurately than ultrasound; they can determine whether fascia and rectus abdominis muscles are involved and if preoperative surgical evaluation is needed for reticular repair of the abdominal wall.

    “In the case of extensive lesions, computed tomography or magnetic resonance imaging can assess the location and size of AWE more accurately than ultrasound; moreover, they can prevail for the determination of whether to accumulate fascia and rectus abdominis muscles and if preoperative surgical evaluation is needed for reticular repair of the abdominal wall[3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

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

    Premisecitation

    Clear cell carcinoma of abdominal incision is the most common histological type, followed by endometrioid carcinoma.

    “Clear cell carcinoma of abdominal incision is the most common histological type, followed by endometrioid carcinoma[16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] source

      Not checked in the free run.

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

    Premisecitation

    Anand et al described the appearance of ectopic umbilical scar nodules being usually above the incision, with brown skin changes on the surface of the nodules.

    “Anand et al[9] described the appearance of ectopic umbilical scar nodules being usually above the incision, with brown skin changes on the surface of the nodules, consistent with the appearance in our case (Figure 1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] source

      Not checked in the free run.

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

    Premisecitation

    According to Akbarzadeh-Jahromi et al, there have been 17 cases of laparoscopic incision endometriosis reported in the English literature.

    “According to Akbarzadeh-Jahromi et al[5], there have been 17 cases reported in the English literature.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Akbarzadeh-Jahromi M, Motavas M, Fazelzadeh A. Recurrent abdominal wall endometriosis at the trocar site of laparoscopy: A rare case. Int J Reprod Biomed (Yazd) 2018; 16: 653-656 source

      Not checked in the free run.

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

    Premisecitation

    Many cases of AWE are misdiagnosed as hernia, and one case was misdiagnosed as umbilical granuloma.

    “It has been reported that many cases are misdiagnosed as hernia[5,12], and one case was misdiagnosed as umbilical granuloma[13].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [5] Akbarzadeh-Jahromi M, Motavas M, Fazelzadeh A. Recurrent abdominal wall endometriosis at the trocar site of laparoscopy: A rare case. Int J Reprod Biomed (Yazd) 2018; 16: 653-656 source

      Not checked in the free run.

    • cites [12] source

      Not checked in the free run.

    • cites [13] source

      Not checked in the free run.

26 of 26

  • The paper relies on this without support.

    Incisional endometriosis after laparoscopy, if it occurs, is usually seen in the cannula incision from which the specimen was collected.

    “Incisional endometriosis after laparoscopy is very rare, and if occurring, it is often seen in the cannula incision of that collected specimen.”
1 of 1

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?

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.

  • Time since the umbilical nodule appeared differs

    Major

    The abstract describes a 2-year history of swelling, but the history of present illness says the umbilical nodules appeared about 4 years before presentation.

  • Time since ovarian surgery differs between sections

    Major

    The abstract places the laparoscopic ovarian cystectomy 4 years before presentation, while the case history places the ovarian cyst removal 6 years before presentation.

2 of 2

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Related

Authors
Ao, X., Xiong, W., & Tan, S.-Q.
Affiliations
Sichuan University (CN)
ORCID
Xiong, Wei
Venue
World Journal of Clinical Cases
Publisher
Baishideng Publishing Group Inc.
Published
2020-04-26
Volume
8
Issue
8
Pages
1532-1537
ISSN
2307-8960 (ISSN-L)
DOI
10.12998/wjcc.v8.i8.1532
PMC
PMC7190959
OpenAlex
W3018418746
Semantic Scholar
636ebb7e550158a7d469a6399e52c7d07db3a2a5
Cited by
7
References
16
Citations by year
2026: 1 · 2025: 1 · 2023: 1 · 2022: 3 · 2021: 1
FWCI
1.10
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • World Journal of Clinical Cases (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
Keywords
abdominal wall endometriosis, postoperative endometriosis, laparoscopic ovarian cystectomy, leuprolide, dysmenorrhea

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