Endometrioma con Diagnostico Tardio
Femenina 39 años edad que, con gran temor ,viene a revisión porque nota un 'bulto' doloroso, en región infraumbilical ,a la derecha de la cicatriz de dos cesáreas previas. La paciente ha tenido tres gestaciones, las dos primeras terminaron en cesáreas, la última con parto vía vaginal. La paciente dice que solo lleva unos meses con ese dolor y en principio negaba su relacion con los periodos menstruales, luego de conversar con ella, cae en la cuenta que tiene ese problema desde su última cirugía ( hace 12 años ). El examen del area muestra imagen nodular, hipoecogenica, de limites ligeramente irregulares, mide aprox: 2,81 X 2,19 cm. Aplicando el Doppler Color apreciamos flujo normal en la zona nodular y en su periferia. La Elastografia muestra patrón tricolor (score 2 de Ueno), lo cual es un patrón de elasticidad que sugiere lesión benigna. Se concluye con el diagnóstico de Endometrioma por siembra en pared abdominal, relacionada con la cesarea de hace 12 años.
Llama la atención que un caso de implantación de células endometriales en la pared abdominal tardara tanto en ser diagnosticado, asumimos que esto se debe al miedo manifiesto de la paciente a la actuación médica, debido a experiencias traumáticas de la paciente con actos médicos previos.
Female 39 years old who, with great fear, comes to review because she notices a painful 'bulge', in the infra-umbilical region, to the right of the scar of two previous cesareans. The patient had three pregnancies, the first two ended in cesarean sections, the last with vaginal delivery. The patient says that it only takes a few months with this pain and in principle denied their relationship with the menstrual periods, after talking with her, falls into the account that has that problem since her last surgery (12 years ago). Examination of the area shows a nodular, hypoechogenic image with slightly irregular borders, measuring approximately 2.81 X 2.19 cm. Applying color Doppler we see a normal flow in the nodular area and in its periphery. Elastography shows a tricolor pattern (Ueno score 2), which is a pattern of elasticity that suggests a benign lesion. We conclude with the diagnosis of Endometrioma by sowing in the abdominal wall, related to the cesarean of 12 years ago.
It is noteworthy that a case of implantation of endometrial cells in the abdominal wall takes so long to be diagnosed, we assume that this is due to the manifest fear of the patient to the medical performance, due to traumatic experiences of the patient with previous medical acts.
Endometrioma with Late Diagnosis
Female 39 years old who, with great fear, comes to review because she notices a painful 'bulge', in the infra-umbilical region, to the right of the scar of two previous cesareans. The patient had three pregnancies, the first two ended in cesarean sections, the last with vaginal delivery. The patient says that it only takes a few months with this pain and in principle denied their relationship with the menstrual periods, after talking with her, falls into the account that has that problem since her last surgery (12 years ago). Examination of the area shows a nodular, hypoechogenic image with slightly irregular borders, measuring approximately 2.81 X 2.19 cm. Applying color Doppler we see a normal flow in the nodular area and in its periphery. Elastography shows a tricolor pattern (Ueno score 2), which is a pattern of elasticity that suggests a benign lesion. We conclude with the diagnosis of Endometrioma by sowing in the abdominal wall, related to the cesarean of 12 years ago.
It is noteworthy that a case of implantation of endometrial cells in the abdominal wall takes so long to be diagnosed, we assume that this is due to the manifest fear of the patient to the medical performance, due to traumatic experiences of the patient with previous medical acts.
