Cited by 49Endometriosis Research and TreatmentMinimally Invasive Surgical TechniquesGynecological conditions and treatments

Laparoscopic trocar port site endometriosis: a case report and brief literature review.

Open access
Emre, Arif, Akbulut, Sami, Yilmaz, Mehmet, Bozdag, Zehra·2012·International Surgery

Abstract

Endometriosis is defined as the presence of ectopic endometrial tissue outside the lining of the uterine cavity. It occurs most commonly in pelvic sites such as ovaries, cul-de-sac, and fallopian tubes but also can be found associated with the lungs, bowel, ureter, brain, and abdominal wall. Abdominal wall endometriosis, also known as scar endometriosis, is extremely rare and mainly occurs at surgical scar sites. Although many cases of scar endometriosis have been reported after a cesarean section, some cases of scar endometriosis have been reported after an episiotomy, hysterectomy, appendectomy, and laparoscopic trocar port tracts. To our knowledge, 14 case reports related to trocar site endometriosis have been published in the English language literature to date. Herein, we present the case of a 20-year-old woman (who had been previously operated on for left ovarian endometrioma 1.5 years ago by laparoscopy) with the complaint of a painful mass at the periumbilical trocar site with cyclic pattern. Consequently, although rare, if a painful mass in the surgical scar, such as the trocar site, is found in women of reproductive age with a history of pelvic or obstetric surgery, the physician should consider endometriosis.

Integrity signals

Registry

Crossref · 10.9738/cc124.1

Cites

21 of 21 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 14 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Pathological examination of the excised mass showed endometriosis, with endometrial glands and stroma in connective tissue and hemosiderin-laden macrophages.

    “Pathologic examination revealed foci of endometriosis comprising endometrial glands and stroma within connective tissue, along with hemosiderinladen macrophages (Figs. 3 and 4).”
    Quote in the paperSubstantial claim
  • Findingown data

    A hard, painful mass adherent to surrounding tissues was palpated at the 10-mm trocar port site.

    “On palpation, a hard, painful mass fixed to the surrounding tissues was detected at the 10-mm trocar port site.”
    Quote in the paperSubstantial claim
  • Findingown data

    At surgical exploration a 4 x 3-cm dense mass, fixed to surrounding tissues and extending into the posterior rectus fascia, was found.

    “At surgical exploration under spinal anesthesia, a 4 3 3-cm dense mass, which was fixed to the surrounding tissues and extended into the posterior rectus fascia, was observed.”
    Quote in the paperNot a substantial claim
  • Findingown data

    A search of PubMed, Google Scholar and Medline identified 14 English-language articles on trocar site endometriosis.

    “To our knowledge, 14 case reports related to trocar site endometriosis have been published in the English language literature to date.”
    • Also stated in: § Discussion · plain
      “In searches of the PubMed, Google Scholar, and Medline databases using the search terms ''endometriosis,'' ''scar endometriosis,'' ''abdominal wall endometriosis,'' and ''trocar,'' alone and in various combinations, we found 14 English-language articles on trocar site endometriosis.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The literature search identified all English-language reports of trocar site endometriosis.
  • Findingown data

    MRI showed an isohyperintense mass located roughly 2-3 cm beneath the umbilicus, slightly left of the midline.

    “Abdominal magnetic resonance imaging (MRI) showed an isohyperintense mass localized approximately 2 to 3 cm below the umbilicus and just to the left of the midline (Figs. 1 and 2).”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 4
  • May combine two claims. 9
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Full texts were obtained for 10 of the articles, covering 13 patients, and their data are summarised in Table 1.

    “Table 1 summarizes the data from the 10 articles (13 patients) for which we obtained the full text.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    A 20-year-old woman presented with a painful, cyclic periumbilical mass at a trocar port site, 1.5 years after laparoscopic removal of a left ovarian endometrioma.

    “Herein, we present the case of a 20-year-old woman (who had been previously operated on for left ovarian endometrioma 1.5 years ago by laparoscopy) with the complaint of a painful mass at the periumbilical trocar site with cyclic pattern.”
    • Also stated in: § Case Report · plain
      “A 20-year-old female patient, who was married and had a child, was admitted to our outpatient clinic complaining of pain and a palpable swelling in the abdominal wall.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    The patient reported that her abdominal wall pain started a few months after the laparoscopic operation, followed a cyclic pattern, and had become progressively worse over the preceding four months.

    “On this admission, she stated that the pain in the abdominal wall commenced a few months after the laparoscopic surgery, was cyclic in nature, and had worsened progressively over the previous 4 months.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Two healed trocar port scars were seen: a 10-mm periumbilical port and a 5-mm port over the left rectus muscle.

    “Inspection showed 2 healed scars compatible with trocar port sites: one inferior to the umbilicus (periumbilical trocar; 10 mm) and the other over the rectus muscle on the left side (left side trocar; 5 mm).”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim.

    Interpretationreasoning

    When a woman of reproductive age who has had pelvic or obstetric surgery presents with a painful mass in a surgical scar, including a trocar site, endometriosis should be considered.

    “Consequently, although rare, if a painful mass in the surgical scar, such as the trocar site, is found in women of reproductive age with a history of pelvic or obstetric surgery, the physician should consider endometriosis.”
    • Also stated in: § Discussion · plain
      “In conclusion, although rare, if a painful mass in a surgical scar such as a trocar site is found in women of reproductive age with a history of pelvic or obstetric surgery, the physician should consider endometriosis.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    In women with abdominal wall masses related to endometriosis, ultrasound-guided fine-needle aspiration is a quick and accurate test that can rule out malignancy and guide treatment.

    “US-guided FNA is a rapid, accurate diagnostic procedure in women with abdominal wall masses associated with endometriosis, enabling malignancy to be excluded and definitive treatment to be determined.20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] 20. Hensen JH, Van Breda Vriesman AC, Puylaert JB. Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography. AJR Am J Roentgenol 2006;186(3):616-620 source
  • May combine two claims.

    Premisecitation

    The CT and MRI features of abdominal wall endometriosis are nonspecific, both showing a solid enhancing mass.

    “The CT and MRI characteristics of abdominal wall endometriosis are nonspecific, with both showing a solid enhancing mass in the abdominal wall.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] 5. Akbulut S, Sevinc MM, Bakir S, Cakabay B, Sezgin A. Scar endometriosis in the abdominal wall: a predictable condition for experienced surgeons. Acta Chir Belg 2010;110(3):303-307 source
  • May combine two claims.

    Interpretationreasoning

    Widespread laparoscopic use by gynaecologists for ovarian cyst excision, tubal ligation and investigation of pelvic pain can lead to trocar site endometriosis, because some of these patients have asymptomatic endometriosis.

    “The widespread use of laparoscopic approaches by gynecologists for ovarian cyst excision, tubal ligation, and exploration in attempts to elucidate the origins of pelvic pain can result in the development of trocar site endometriosis due to the simultaneous presence of asymptomatic endometriosis in a proportion of these patients.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: A proportion of patients who undergo laparoscopy for ovarian cyst excision, tubal ligation or investigation of pelvic pain have asymptomatic endometriosis.
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Incisional hernia, particularly with large-diameter trocars, is the most frequent complication of trocar port sites.

    “Whereas the most frequent complication is an incisional hernia, especially with large-diameter trocars, tumor cell seeding along the trocar tract and trocar site endometriosis are two rare complications.9”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] 9. Sirito R, Puppo A, Centurioni MG, Gustavino C. Incisional hernia on the 5-mm trocar port site and subsequent wall endometriosis on the same site: a case report. Am J Obstet Gynecol 2005;193(3, pt 1):878-880 source
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Medical treatment for scar endometriosis includes nonsteroidal anti-inflammatory drugs, oral contraceptives, gonadotropin-releasing hormone analogues, aromatase inhibitors and radiofrequency ablation.

    “Medical therapy is also used in the treatment of scar endometriosis and includes nonsteroidal anti-inflammatory agents, oral contraceptives, gonadotropin-releasing hormone analogues, aromatase inhibitors, and radiofrequency ablation therapy.5”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] 5. Akbulut S, Sevinc MM, Bakir S, Cakabay B, Sezgin A. Scar endometriosis in the abdominal wall: a predictable condition for experienced surgeons. Acta Chir Belg 2010;110(3):303-307 source
  • May combine two claims.

    Premisecitation

    Both seeding of tumour cells along the trocar tract and endometriosis at the trocar site are uncommon complications.

    “Whereas the most frequent complication is an incisional hernia, especially with large-diameter trocars, tumor cell seeding along the trocar tract and trocar site endometriosis are two rare complications.9”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] 9. Sirito R, Puppo A, Centurioni MG, Gustavino C. Incisional hernia on the 5-mm trocar port site and subsequent wall endometriosis on the same site: a case report. Am J Obstet Gynecol 2005;193(3, pt 1):878-880 source
  • May combine two claims.

    Premisecitation

    A trocar port site endometrioma may arise either from peritoneal seeding of cells caused by pneumoperitoneum or from direct contact between the excised lesion and the port tract.

    “A trocar port site endometrioma might develop from the peritoneal seeding of cells because of pneumoperitoneum or from direct contact of the excised lesion with the port tract.5,8”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] 5. Akbulut S, Sevinc MM, Bakir S, Cakabay B, Sezgin A. Scar endometriosis in the abdominal wall: a predictable condition for experienced surgeons. Acta Chir Belg 2010;110(3):303-307 source
    • cites [8] 8. Barbaros U, Iyibozkurt AC, Gulluoglu M, Barbaros M, Erbil Y, Tunali V et al. Endometriotic umbilical port site metastasis after laparoscopy. Am J Obstet Gynecol 2005;193(5):1761-1763 source
12 of 12
  • The paper relies on this without support.

    A proportion of patients who undergo laparoscopy for ovarian cyst excision, tubal ligation or investigation of pelvic pain have asymptomatic endometriosis.

    “due to the simultaneous presence of asymptomatic endometriosis in a proportion of these patients”
  • The paper relies on this without support.

    The literature search identified all English-language reports of trocar site endometriosis.

    “we found 14 English-language articles on trocar site endometriosis”
2 of 2

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?

  • A trocar port site endometrioma may arise from direct contact between the excised lesion and the port tract or by peritoneal seeding of cells due to pneumoperitoneum.

    “A trocar port site endometrioma may arise from direct contact between the excised lesion and the port tract or by peritoneal seeding of cells due to pneumoperitoneum [21,43].”
  • Precautions such as collecting specimens in endo bags, cleaning incision sites, and carefully closing the abdomen in patients with a history of endometriosis or pelvic endometriosis discovered during laparoscopy can prevent trocar site endometriosis.

    “Precautions such as collecting specimens from the abdominal cavity in endo bags, cleaning the incision sites, and carefully closing the abdomen cavity in patients who have a history of endometriosis or in whom pelvic endometriosis was discovered during laparoscopy can prevent the development of trocar site endometriosis [21].”
  • Widespread use of laparoscopic approaches by gynecologists for ovarian cyst excision, tubal ligation, and pelvic pain exploration can result in trocar site endometriosis due to concurrent asymptomatic endometriosis.

    “Due to the concurrent presence of asymptomatic endometriosis in a portion of these patients, the widespread use of laparoscopic approaches by gynecologists for ovarian cyst excision, tubal ligation, and exploration to determine the cause of pelvic pain can result in the development of trocar site endometriosis [21,44].”
  • 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].”

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Authors
Emre, A., Akbulut, S., Yilmaz, M., & Bozdag, Z.
Affiliations
  • Department of Surgery, Malatya State Hospital, Malatya, Turkey
  • Inonu University (TR)
  • Department of Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
  • Department of Pathology, Malatya State Hospital, Malatya, Turkey
Venue
International Surgery
Published
2012-10
Volume
97
Issue
2
Pages
135-139
ISSN
  • 0020-8868 (ISSN-L)
  • 2520-2456
OpenAlex
W1984485500
Cited by
49
References
26
Citations by year
2026: 1 · 2025: 2 · 2024: 2 · 2022: 9 · 2021: 2 · 2020: 6 · 2019: 1 · 2018: 3 · 2017: 8 · 2016: 4 · 2015: 3 · 2014: 6 · 2013: 2
FWCI
4.10
Type
journal article
Language
en
Open access
Locations
  • International Surgery (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • 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
endometriosis, scar endometriosis, abdominal wall endometriosis, endometrioma
MeSH terms
Cicatrix, Endometriosis, Female, Humans, Magnetic Resonance Imaging, Laparoscopy, Postoperative Complications, Abdominal Wall, Young Adult

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