New Case Study: a woman with severely aggresive external Endometriosis

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A newly published study about a 35-year-old woman with a case of crazy-insane-aggressive Endometriosis hit my inbox.  I was going to fit it into a previously-written blog about hysterectomies and Endo or extra-pelvic Endo…but it was so fascinating that I decided to create today’s blog entry.

Initially, this young woman had abdominal surgery to remove her right ovary because of a ruptured ovarian cyst.  She subsequently had three additional surgeries to excise Endometriomas (chocolate cysts) and adenomyosis via a total hysterectomy which also took both of her fallopian tubes and remaining ovary.

After her 2007 surgery, her pain levels were still severe and present.  Her physicians started her on daily doses of 2.5mg Letrozole, even though she was already on Danazol every day.    It provided her with some relief and in 2012 she asked that her Letrozole dose be increased to 7.5mg.  Her physicians allowed it, but with it came increased side effects of weight gain, headaches, extremity pain, dizziness, insomnia, and memory impairment.  She asked that they decreased the dosage to 5mg.

With the decrease to 5mg, her Endometriosis relapsed and was found present in her abdominal wall, vulva, and labia majora.  They increased her Letrozole dosage back up to 7.5mg and surgery was performed (and continued to be repeated in the future).  The only pain relief she ever received was after surgeries to remove the Endo lesions and while she maintained an increased dose of Letrozole.

This poor woman had a total of 175 (yep; you read that right) surgical procedures from 1998 to 2013 to treat her aggressive Endometriosis.  Her only pain relief was on a triple-the-usual dosage amount of Letrozole which she then had the severe side effects from the medication to deal with.

I cannot even imagine!!!  Although I do wish the study outlined further details: what types of procedures, ablation or excision, diet, exercise, lifestyle, family history, etc.  A lot of different factors may affect pain and symptoms (although I’m not belittling her experience at all) – I would just really like to know…

If you’d like to read the entire study (and see the photographs), please click on the link below.

Resources:

Journal of Clinical Case Reports (Article; 2017) – A Severe Case of Recurrent External Endometriosis in an Ovariectomized Young Woman

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research ūüėČ Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

A New Publication re: Abdominal Wall Endometriosis

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Some of you may have read¬†my previous blog about Cesarean scars and Endometriosis (if you haven’t, you can read it here). ¬†In the studies referenced in that blog entry, all of the women complained of bumps or lumps or pain in their c-section scars. ¬†Turns out they had developed Endometriosis in their scar tissue; likely the cells were transferred during the surgical procedure.

But…correspondence¬†published just a few days ago references a woman who was found to have Endometriosis growing within the fascia of¬†her abdominal wall nearly 1.25 inches above her scar line. ¬†She was 41-years-old and had complaints of the bump for the past 3 years. ¬†It didn’t bug her; she had no symptoms. ¬†It wasn’t discolored…it was just a mass. ¬†A bump. ¬†A lump…that just sat there. ¬†She had previously undergone two c-sections (one seven years ago and one 10 years ago). ¬†An ultrasound classified the lump as a cyst, nearly 32 x 23mm (1″ x 1.25″) in size and doppler scanning showed it had a blood flow. ¬†So, a biopsy was taken, which¬†revealed it was an Endometriosis mass. ¬†It was excised and hadn’t come back within six months. ¬†But it was, in fact, confirmed as Endometriosis.

The authors hope that this leads¬†healthcare workers to consider the possibility that masses outside of¬†abdominal scarring may be Endometriosis. ¬†They’re not just limited to appearing within surgical scars. ¬†The mass¬†needs to be¬†biopsied and handled accordingly. ¬†If you’d like to read the study, it’s linked below.

Subsequent to the writing of this original blog post, I learned of another episode of abdominal wall Endometriosis (so I’m updating it here). ¬†A 36-year-old woman who had no medical history except for a c-section complained of a lump (that didn’t hurt at all) on the left side of her lower abdomen. ¬†An ultrasound found¬†thickening of the abdominal muscle in that spot and an MRI was able to confirm that this thickening was a lesion which gave signs of bleeding. ¬†Her doctor suspected abdominal wall Endometriosis and excised the mass.

A recent April 2018 study was published about a 36-year-old woman who complained of a pain along her appendectomy scar.¬† She had her appendix removed previously and pain had begun along her scar line two years ago. It continued to worsen until she found herself in the ER because of the severity of the pain.¬† A CT scan identified a mass withiin her abdominal wall.¬† Surgery was performed, the lump was excised (along with nearby “chocolate shaped secretion areas” which were located between internal muscles), and a biopsy confirmed the lump was Endometriosis.¬† Appendectomy scar Endometriosis may be incredibly difficult to diagnose without surgery.

Got a bump¬†in or around your c-section scar? ¬†Talk to your doctor! ¬†Haven’t had a c-section, but still have a lump or bump? ¬†You should still go talk to your doctor.

*Updated May 24, 2018*

Resources:

Clinical & Experimental Dermatology – (Article; Jan. 2017) Development of Abdominal Wall Endometriosis in a Region Distant from a Cesarean Scar

Journal of Clinical Urology (May 2017; Article) Abdominal Wall Endometriosis

Middle East J Dig Dis (April 2018; Article) Appendectomy Scar Endometriosis: A Case Report

~ Again, I am a layman. ¬†I do not hold any college degrees, nor mastery of knowledge. ¬†Please take what I say with a grain of salt. ¬†If curious, do your own research ūüėČ Validate my writings. ¬†Or challenge them. ¬†And ALWAYS feel free to consult with your physician. Always. ¬†Yours ~ Lisa