Rare presentation of scar endometriosis in atypical and typical locations: a case series

Rare presentation of scar endometriosis in atypical and typical locations: a case series DOI: https://doi.org/10.18203/2320-1770.ijrcog20260196Keywords: Scar endometriosis, Caesarean section scar, Umbilical endometriosis, Episiotomy scar, Surgical scarAbstract Scar endometriosis is an uncommon but well-documented entity resulting from the iatrogenic implantation of endometrial tissue into surgical scars. It is most frequently seen following caesarean section or other obstetric and gynaecological procedures and is often misdiagnosed due to its rarity and variable presentation. This case series presents patients with scar endometriosis involving both classical and unusual sites, highlighting diagnostic challenges and management outcomes. Patients with clinically and histopathologically confirmed scar endometriosis managed at Kasturba Hospital, Delhi over a two-year period were evaluated with respect to presenting symptoms, site of involvement, surgical history, diagnostic work-up, treatment, and follow-up. All patients presented with cyclical pain and swelling at or near surgical scars, with some demonstrating uncommon locations such as the episiotomy scar, umbilicus, and lateral abdominal wall. Surgical excision of the lesions with clear margins resulted in complete symptom relief in all cases. Histopathological examination confirmed the presence of endometrial glands and stroma in all excised specimens. No recurrence was observed during the follow-up period. Scar endometriosis should be suspected in women presenting with cyclical pain and swelling at or near surgical scars, particularly following obstetric or gynaecological procedures. Awareness of atypical presentations facilitates early diagnosis and effective surgical management. Metrics References Rindos NB, Mansuria SM. Diagnosis and management of abdominal wall endometriosis: a systematic review. Obstet Gynecol Surv. 2017;72(2):116-22. Khan Z, Zanfagnin V, El-Nashar SA, Famuyide AO, Daftary GS, Hopkins MR. Abdominal wall endometriosis: clinical presentation and outcomes. J Minim Invasive Gynecol. 2017;24(3):478-84. DOI: https://doi.org/10.1016/j.jmig.2017.01.005 Vellido-Corroto I, García-Gómez O, Muñoz-González JL, et al. Abdominal wall endometriosis: pathogenesis, diagnosis and management. J Obstet Gynaecol Res. 2019;45(11):2019-28. Zhang P, Sun Y, Zhang C, Yang Y, Zhang L, Wang N, et al. Cesarean scar endometriosis: presentation of 198 cases and literature review. BMC Womens Health. 2019;19(1):14. DOI: https://doi.org/10.1186/s12905-019-0711-8 Horton JD, Dezee KJ, Ahnfeldt EP, Wagner M. Abdominal wall endometriosis: a surgeon’s perspective. Am J Surg. 2018;196(2):207-12. DOI: https://doi.org/10.1016/j.amjsurg.2007.07.035 Agarwal A, Fong YF. Cutaneous endometriosis. Singapore Med J. 2008;49(9):704-9. Al-Jabri K, Tulandi T. Surgical management of abdominal wall endometriosis. Best Pract Res Clin Obstet Gynaecol. 2021;71:82-92. Leite GK, Carvalho LF, Korkes H, Guazzelli TF, Kenj G, Viana AT. Scar endometrioma following obstetric surgical procedures. Sao Paulo Med J. 2009;127(5):270-7. DOI: https://doi.org/10.1590/S1516-31802009000500005 Taburiaux L, Pluchino N, Petignat P, Wenger JM. Endometriosis-associated abdominal wall cancer. Int J Gynecol Cancer. 2015;25(9):1633-8. DOI: https://doi.org/10.1097/IGC.0000000000000556 Goel P, Sood SS, Dalal A, Romilla. Cesarean scar endometriosis—report of two cases. Indian J Med Sci. 2005;59(11):495-8. DOI: https://doi.org/10.4103/0019-5359.18967 Balleyguier C, Chapron C, Chopin N, Hélénon O, Menu Y. Abdominal wall and surgical scar endometriosis: MRI findings. Gynecol Obstet Invest. 2003;55(4):220-4. DOI: https://doi.org/10.1159/000072078 Nominato NS, Prates LF, Lauar 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: https://doi.org/10.1016/j.ejogrb.2010.05.001 Medeiros FD, Cavalcante DI, Medeiros MA, Eleutério J Jr. Fine-needle aspiration cytology of scar endometriosis. Diagn Cytopathol. 2011;39(1):18-21. DOI: https://doi.org/10.1002/dc.21319 Kumar S, Sharma JB, Verma D, et al. Scar endometriosis: clinical profile and management. J Obstet Gynaecol India. 2022;72(4):345-51. Rindos NB, Mansuria SM. Medical management of abdominal wall endometriosis. Obstet Gynecol Surv. 2017;72(2):116-122. DOI: https://doi.org/10.1097/OGX.0000000000000399 Bektaş H, Bilsel Y, Sarı YS, Ersoz F, Koc O, Deniz M, et al. Malignant transformation of abdominal wall endometriosis. World J Surg Oncol. 2016;14:97.