A technique currently used on patients with breast lesions can be adapted to help locate and successfully remove lesions in women with abdominal wall endometriosis, according to a new case report from Brazil.
The study, “Use of radioguided surgery in abdominal wall endometriosis: An innovative approach,” appeared in the World Journal of Nuclear Medicine.
Endometriosis primarily affects the pelvic area, including the ovaries, fallopian tubes, and the vagina. Rare cases outside the pelvis also occur, involving the bladder, bowel, and other areas.
Endometriosis may be present in scar tissue resulting from prior abdominal incisions, such as laparoscopy and the more invasive laparotomy, as well as from hernia repair. Collectively, this is known as abdominal wall endometriosis.
Women with this type of endometriosis may experience abdominal pain, a palpable mass, painful periods (dysmenorrhea), painful sexual intercourse (dyspareunia), irregular menstrual cycles, and infertility.
The occurrence of endometriosis in the anterior abdominal wall is frequently correlated with prior cesarean delivery. Diagnosis may be complicated due to its rarity and the lack of familiarity among clinicians.
In this study, researchers presented the case of a 43-year-old patient who previously underwent a cesarean delivery and had a diagnosis of pelvic endometriosis for more than 10 years. She complained of progressive abdominal pain, despite using Mirena, an intrauterine device indicated for the treatment of menorrhagia, or heavy menstrual bleeding.
Magnetic resonance imaging and an ultrasound scan showed a 1.6-cm cyst and debris located in the mid-lower portion of the rectus abdominis, a large muscle extending from a bone called the sternum to the pubis. This finding suggested abdominal wall endometriosis, according to the investigators.
The patient’s abdominal wall injury was unidentifiable, or impalpable, during clinical examination. The clinicians opted to use a preoperative marking technique with a radioisotope called Radioguided Occult Lesion Localization (ROLL). This technique is used in the localization and removal of similar impalpable breast lesions.
With the help of a portable gamma probe — a device used to detect radiation during surgeries — the clinicians rapidly identified the lesions, which allowed for their complete removal. Subsequent analysis confirmed the diagnosis of abdominal wall endometriosis.
Overall, the findings suggested that locating impalpable lesions in the abdominal wall “is a promising new indication for the use of ROLL technique,” the researchers wrote.
“In addition to increasing surgical precision, [ROLL] can positively impact the operative time and morbidity,” they added.