The Unknown Cesarean Risks

Welcome

My name is Ana and I am 34 years old. Four years ago I had my first child delivered by C-Section. I never thought that my health would take a radical turn from an “overlooked” cesarean risk.

During my cesarean section, I was implanted with endometrium tissue (uterus lining) in my abdominal rectus muscle. I spent the next three years in extreme pain. I was seen by OBGYNs and general physicians for my lump and symptoms in over 30 visits, only to be undiagnosed or misdiagnosed over those three years. I kept telling the doctors to check my lump, but the doctors kept saying, “Scar tissue has no symptoms.”

None of my doctors ever checked to confirm that the lump was not scar tissue. During those three years my lump grew. When I finally got diagnosed the doctors told me that the lump was an endometrioma mass that grew and attached to my abdominal rectus muscle. When I had my surgery to remove the mass, surgeons had to remove 8 cm of my muscle, the muscle sheath, vein complex and the inferior epigastric artery.

I no longer have pain from the endometrioma mass, but I am left with a permanent herniated stomach, incapacitated from many daily activities, and cannot carry another pregnancy. I have no pelvic endometriosis; the endometrioma mass found in my abdomen was the direct implantation of my endometrium cells during my cesarean. There was nothing in place to prevent this event from happening or to diagnose me at earlier stage. My doctors completely ignored my lump and symptoms. They refused to believe me though all along I was pointing at the problem.

I’m sharing my story, in the hope of raising awareness and informing the public of this overlooked cesarean risk, to help change the outcome for other women.

Please take a moment to read my story

My Mission

My mission is to raise public awareness of this overlooked and misdiagnosed cesarean risk. Women and doctors need to know what to look for when postpartum problems arise. Doctors need to be well aware of this condition, so women can get early diagnosis and treatment, which is vital with this progressive condition.

Endometrioma Mass

Your painful “Scar Tissue” might be an Endometrioma Mass!

A palpable subcutaneous mass (lump) near the cesarean scar, is your pain in-sync with the monthly menstrual cycle?

Abdominal wall endometriosis (endometrioma mass) develops in a surgical scar resulting from a Caesarean section. While commonly seen in the cutaneous and subcutaneous fat tissue at the Caesarean scar level, it also found intramuscular. This overlooked cesarean risk is often never included as a possible diagnostic even when symptoms and lump make the diagnostic easy. Doctors easily diagnose these painful lumps without further testing as: Lipoma, Scar Tissue, Hernia, etc. It’s thought to be a “rare risk” but many cases go without being reported or diagnosed properly. With Cesarean procedure on the rise this “rare risk” happens more often than we all think. All medical literature states abdominal wall endometriosis is a cesarean risk. It can happen in women with no prior or current endometriosis.

To find unbiased case reports from all over the world about this condition visit: http://www.ncbi.nlm.nih.gov/pubmed

I wished I had this info-graphic back in the days when I was going through it and none of my diagnostic made sense. After my surgery I’ve made my mission to inform the public of this overlooked cesarean risk so that it can be diagnosed and treated in time.

To view info-graphic click on the image bellow:

Endometrioma Mass

 

Transcription Report

Transcription Report

PREOPERATIVE DIAGNOSIS:
Left-sided lower abdominal wall mass, thought to be an endometrioma.

POSTOPERATIVE DIAGNOSIS:
An 8 cm intramuscular left-sided abdominal wall mass.

PROCEDURE PERFORMED:
Radical excision of left-sided abdominal wall mass endometrioma, with Flex HD allograft ultra-thick construction using a total 10 x 16 cm for a total of 160 cm2 allograft repair of the abdominal wall.

FINDINGS:
The patient had an 8 cm soft tissue mass between the anterior rectus sheath and left rectus musculature intertwined with the muscle fascicles and the inferior epigastric artery and vein complex. This required a radical excision to achieve margins to make sure that this does not recur rapidly. It had grown after a C-section, the patient developed an area that was painful and firm.

INDICATIONS FOR PROCEDURE:
An ultrasound directed biopsy was suggestive of an endometrioma. Patient was referred to our office by Dr. for the evaluation and management of this problem.

PROCEDURE IN DETAIL:
The patient received perioperative antibiotics consisting of Ancef. She voided. Sequential pneumatics were placed on her lower extremities. She received 2500 units of Fragmin subcu preop for VTE prophylaxis. The site was marked with her help in the preoperative holding area. She was identified, brought to the operating room and placed supine on the operating room table.

A time-out was done and then a general anesthetic was induced. Her anterior abdominal wall was prepared and draped, 0.25 percent Marcaine with epinephrine was infused through her old C-section scar and a transverse skin incision was made encompassing the previous scar using the scar as the entrance point. Skin flaps were raised superiorly. I could feel the mass through the left side of the rectus sheath and then a Pfannenstiel style incision was performed on the left side distal to the palpable mass and the entire rectus sheath involved with the palpable mass as well as the fascicles of her rectus muscle on the left side and the inferior epigastric pedicle were taken en bloc, resected and sent to pathology.

We asked if the pathologist could evaluate this mass to make sure there was not any invasive component and looks to be an endometrioma based on his evaluation. We treated as an invasive tumor since it can recur if we do not get good margins. The entire lesion was removed en bloc. The posterior rectus sheath was left intact as was the peritoneum below the semilunar line.

A 10 x 16 thick Flex HD mesh was then cut into 2 parts and a sandwich repair was created by placing this Flex HD below the rectus musculature on the left side and bringing it using horizontal mattress 0 Vicryl sutures through the remaining rectus sheath laterally and through the external oblique fascia laterally and the rectus sheath medially.

An onlay portion of the same mesh was used; it was undermined below the superficial rectus sheath, creating a sandwich with these 2 layers of Flex HD. This was sewn in using a combination of interrupted 0 Vicryl suture, and PDO Stratafix 6-0 suture. The wound was irrigated. A Blake fluted 15 drain was brought in on the patients right side and brought out through a stab wound done in the right inguinal region. Skin flaps all looked viable.

There was no evidence of hemorrhage, 0.25 percent Marcaine with epinephrine was infused for postoperative pain control. A photograph had been taken of the tumor as well as the resection bed. The tumor was measured and found to be 8 cm in total length and then the subcutaneous tissues were reapproximated using a combination of 2-0 Vicryl for Scarpas fascia, followed by 3-0 Vicryl deep dermal reapproximation, followed by 4 – 0 Monocryl subcuticular skin closure followed by Dermabond.

The drain was secured using 3-0 nylon suture and placed to bulb suction. The patient tolerated the procedure well and was returned to the recovery area in stable condition with sponge and needle counts correct at the end of the case.

WARNING!!!  Images below may be disturbing. Viewer discretion advised!

Endo

LumpSymptoms

Symptoms of an Endometrioma Mass

Depending on the location of the mass, symptoms might be different for all iatrogenic endometriosis suffers. Growths of endometriosis masses are benign (not cancerous). But they still can cause many problems for much different reasons. Endometriosis is a progressive disease, which means that symptoms usually get worse over time as the mass grows.

In my case the symptoms started right after my cesarean section, and progressed with time. I would compare the pain that I experienced monthly; as intense as passing kidney stones (a pain that is described by many being worse than child birth).

My list of symptoms:

Continuous:

    • Lump above cesarean incision scar, a slow growing mass, painful and tender to the touch with time
    • Abdominal and surrounding area inflammation
    • Abdominal swelling and bloating
    • Constant lower back pain
    • Sciatica pain
    • Abdominal pain and or discomfort when coughing or sneezing
    • Discomfort when doing any type of activity using core muscles
    • Cramping of abdomen rectus muscle
    • Overall weakness of abdominal muscles
    • Denser and tender breast
    • Weight gain
    • Cystic acne
    • Other unexplained discomfort in the surrounding area caused by nerve cells

During menstrual cycle and follicular phase:

    • Lower abdominal aching, dull, sharp pain that starts few days before menstrual and intensify few days after menstrual cycle
    • Internal heat during menstrual and follicular phase around the lump in abdomen area
    • Intense cramps in the abdominal muscle during menstrual cycle and follicular phase
    • Periodic sharp stabbing pain in the muscle during menstrual and it intensifies during follicular phase
    • Lower back and hips radiating pain during menstrual cycle and it intensifies during follicular phase
    • Itching of the lower abdomen area that would start during menstrual cycle and intensifies after the end of menstrual cycle
    • Intestinal pain, nausea, constipation and diarrhea during menstrual cycle and follicular phase
    • Breast size would increase by 1 cup size up during menstrual cycle
    • Overall body swelling

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