[Abdominal wall endometriosis after caesarean section: report of fifteen cases]. / Endométriose pariétale sur cicatrice de césarienne: à propos de 15 cas.

OBJECTIVE: Parietal endometriosis is an uncommon pathology. It can occur on all the scars, most often after a surgical procedure with hysterotomy. Surgical scar endometriosis following caesarean section has an incidence of 0.03 to 0.4%. PATIENTS AND METHODS: This retrospective study reviewed all the cases of parietal endometriosis seen during a 7-year period in the department of visceral surgery of the Armentière's hospital center. A pathological analysis has confirmed each lesion retained. RESULTS: 15 women were treated during this period. The mean age is 32 years. All the women have one or two antecedents of caesarean with Pfannenstiel's laparotomy. The interval between the caesarean and the appearance of the first symptoms is on average of 5 years and 11 months. Only 66.6% of cases presented the classical symptoms with cyclic pain. For 66.6% of patients, the diagnosis of parietal endometriosis was suspected before the treatment. The treatment is a surgical one with exeresis for all the women. In 13.3% of the cases, the lesion is pre aponeurotic. In 46.6% of the cases, it overgrows the rectus abdominis muscle, in 33.3% of the cases the external abdominal oblique and at last a lesion overgrows the transversus abdominis and one is in an inguinal localization. The mean size of lesions is 2.48 cm. We have not notified complications and no recurrence was noted. DISCUSSION AND CONCLUSION: The local endometrial cell transplant is the most likely mechanism to explain the physiopathology of parietal endometriosis. The classical symptoms associate a painful swelling and cyclic pain related to the menstrual period, but all of these symptoms are not always associated. The contribution to the diagnosis of the imaging studies is weak. The surgical treatment has to be sufficiently wide to avoid all recurrence. No means of prevention has proved its efficiency. In 26.6% of cases the parietal endometriosis is associated to pelvic endometriosis. This localization is more often asymptomatic. Then the realization of a laparoscopic exploration is not indicated immediately.

Small bowel incarceration in a broad ligament defect.

We report the case of a 33-year-old woman whose medical history included three normal pregnancies without previous abdominal or pelvic surgery. She presented with small bowel obstruction. An abdominal computed tomography (CT) scan study revealed air fluid levels in the pelvis. Laparoscopic exploration revealed a viable ileal loop incarcerated through the mesoligamentum teres. The intestinal loop was reduced and the broad ligament defect was closed with a laparoscopic absorbable clip. Among internal hernias, hernias through a defect in the broad ligament represent only 4-7%. Defects within the broad ligament can be either congenital (ruptured cystic structures reminiscent of the mesonephric or mullerian ducts) or secondary to operative trauma, pregnancy and birth trauma, or prior pelvic inflammatory disease. CT scan may be diagnostic by showing incarceration of a dilated intestinal loop in the Douglas pouch with air fluid levels. This is the first reputed case of a totally laparoscopic repair of a bowel incarceration through a broad ligament defect.

[Thrombosed aneurysm of the femoral vein mimicking a strangulated crural hernia]. / Anévrysme thrombosé de la veine fémorale mimant une hernie crurale étranglée.

Venous aneurysms are usually difficult to diagnose, especially when they are located in the inguinal area where they can be misinterpreted as inguinal or femoral hernias. We report the case of a 70-year-old man with a painful thrombosed aneurysm of the femoral vein that was clinically undistinguishable from a strangulated hernia. The ultrasonogram, performed 2 months before the acute pain when the femoral swelling was painless, seemed to confirm the incorrect diagnosis of femoral hernia, and the aneurysm was finally labeled as such during surgical exploration. Massive embolism to the lungs and heart occurred peroperatively and resulted in death.

Round ligament varicosities mimicking inguinal hernia: a diagnostic challenge during pregnancy.

Groin swelling first evokes inguinal or femoral hernia but many other conditions may account for it. We describe varicosities of round ligament in a 27-year-old pregnant woman. She presented with a groin mass mimicking an inguinal hernia. Diagnosis was made during surgical exploration. This case report strengthens the fact that varicosities of the round ligament, favoured by hormonal and mechanical factors, should be evoked in a pregnant woman complaining of a groin mass. Ultrasonographic examination of the groin should be performed in such cases to avoid unnecessary surgery.

Spontaneous retroperitoneal hematoma from rupture of an aneurysm of the ovarian artery following delivery.

We describe a case involving spontaneous retroperitoneal hematoma caused by rupture of an aneurysm of the right ovarian artery 4 days after delivery in a multiparous woman. Diagnosis was achieved by arteriography. Bleeding was stopped by embolization via selective arteriography. Hematoma was drained by lomboscopy. The pathophysiological mechanisms underlying development and treatment of these aneurysms are discussed.

Lumbar hernia: anatomical route assessed by computed tomography.

Lumbar hernia is classically described as arising from the superior (Grynfeltt's) lumbar triangle or the inferior (Jean-Louis Petit's) lumbar triangle. The present anatomical study based on a computed tomography examination performed in a patient with lumbar hernia, has led to the suggestion that lumbar hernias cross the lumbar wall through a musculoaponeurotic tunnel, whose deep and superficial openings are the superior and inferior lumbar triangles, respectively.