Scar Endometriosis - A Case Report

Scar Endometriosis - A Case Report Life Sciences -Gynecology DOI: https://doi.org/10.22376/ijlpr.2023.13.5.L98-L105Keywords: scar endometriosis, cesarean section, abdominal wall endometriosis, abdominal lump, wide excisionAbstract Endometriosis is a common disease affecting women in the reproductive age group. Endometriosis is the presenceand growth of functional endometrial tissue at sites other than the uterus. Scar endometriosis, a type of extrapelvicendometriosis, is the presence of functioning endometrial tissue in the abdominal wall along the scars of previous abdominalsurgeries. About 1-2 % of women who underwent cesarean section have the risk of developing surgical scar endometriosis.We report the case of a 27-year-old woman with a history of two cesarean sections. She presented with pain abdomen and anabdominal lump, which increased during menstruation. On examination, there was a tender lump in the abdomen. A clinicaldiagnosis of scar endometriosis was made. Radiological investigations confirmed the diagnosis. Under anesthesia, the scarendometriosis tissue was removed by wide excision and sent for histopathology, which confirmed the presence of endometrialglands with stroma. The patient was discharged and followed up without any recurrence. This case is reported as a rarecondition, though it is increasing in incidence. The clinical features may mimic many surgical or dermatological conditions;hence there is a high chance of misdiagnosis and unnecessary referral, causing physical and emotional distress to the patient.Basic knowledge of the condition, thorough clinical examination, and radiological imaging are usually effective in diagnosing thecondition. Surgical excision and follow-up form the basis of treatment of scar endometriosis. Though surgery is the mainstay oftreatment and medical treatment does not provide a permanent cure, there is scope for future research to discover innovativemedical methods to provide a permanent cure without surgery. The preventive aspect is also important for the surgeon doingthe primary surgery. However, further evidence-based studies are needed to establish effective methods to prevent thedevelopment of scar endometriosis. References Neri I, Tabanelli M, Dika E, Valeria G, Patrizi A. Diagnosis and treatment of post-Caesarean scar endometriosis. Acta Derm Venereol. 2007;87(5):428-9. doi: 10.2340/00015555-0269, PMID 17721652. Emre A, Akbulut S, Yilmaz M, Bozdag Z. Laparoscopic trocar port site endometriosis: a case report and brief literature review. Int Surg. 2012;97(2):135-9. doi: 10.9738/CC124.1. PMID 23102079. Berek and Novak's Textbook of Gynaecology. 16th ed. Busca A, Parra Herren C, Ovary. Other nonneoplastic; endometriosis. pathological outlines.com.2017. Paşalega M, Mirea C, Vîlcea ID, Vasile I, Pleşea IE, Calotă F, et al. Parietal abdominal endometriosis following cesarean section. Rom J Morphol Embryol. 2011;52(1);Suppl:503-8. PMID 21424102. Uçar MG, Şanlıkan F, Göçmen A. Surgical treatment of scar endometriosis following cesarean section, a series of 12 cases. Indian J Surg. 2015 Dec;77; Suppl 2:682-6. doi: 10.1007/s12262-013-0978-1, PMID 26730088. Horton JD, DeZee KJ, Ahnfeldt EP, Wagner M. Abdominal wall endometriosis: a surgeon’s perspective and review of 445 cases. Am J Surg. 2008 Aug;196(2):207-12. doi: 10.1016/j.amjsurg.2007.07.035, PMID 18513698. Nominato NS, Prates LF, Laura I, Morais J, Maia L, Geber S. Caesarean section greatly increases the risk of scar endometriosis. Eur J Obstet Gynecol Reprod Biol. 2010;152(1):83-5. doi: 10.1016/j.ejogrb.2010.05.001, PMID 20510495. Leite GK, Carvalho LF, Korkes H, Guazzelli TF, Kenj G, Viana Ade T. Scar endometrioma following obstetric surgical incisions: a retrospective study on 33 cases and review of the literature. Sao Paulo Med J. 2009;127(5):270-7. doi 10.1590/s1516-31802009000500005. PMID 20169275. Oh EM, Lee WS, Kang JM, Choi ST, Kim KK, Lee WK. A Surgeon’s Perspective of Abdominal Wall Endometriosis at a Caesarean Section Incision: Nine Cases in a Single Institution. Surg Res Pract. 2014;2014:765372. doi: 10.1155/2014/765372, PMID 25379559. Zhang J, Liu X. Clinicopathological features of endometriosis in the abdominal wall – clinical analysis of 151 cases. Clin Exp Obstet Gynecol. 2016;43(3):379-83. doi: 10.12891/ceog2126.2016, PMID 27328495. Hensen JH, Van Breda Vriesman AC, Puylaert JB. Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography. AJR Am J Roentgenol. 2006 Mar;186(3):616-20. doi: 10.2214/AJR.04.1619, PMID 16498086. Al-Jabri K. Endometriosis at caesarian section scar. Oman Med J. 2009 Oct;24(4):294-5. doi: 10.5001/omj.2009.59, PMID 22216383. Minaglia S, Mishell DR Jr, Ballard CA. Incisional endometriomas after Cesarean section: a case series. J Reprod Med. 2007 Jul;52(7):630-4. PMID 17847762. Picod G, Boulanger L, Bounoua F, Leduc F, Duval G. Abdominal wall endometriosis after cesarean section: report of fifteen cases. Gynecol Obstet Fertil. 2006 Jan;34(1):8-13. doi: 10.1016/j.gyobfe.2005.11.002, PMID 16406732. Published How to Cite Issue Section Copyright (c) 2023 Preethi Bose, Varrshine R, Thanka J This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.