Scar Endometriosis: Clinical Features, Diagnosis, and Surgical Management – A Case Series

Scar endometriosis is a rare form of extrapelvic endometriosis characterized by the presence of functional endometrial tissue within or adjacent to surgical scars, most commonly following cesarean section. Due to its variable clinical presentation, it is often misdiagnosed, leading to delayed management. We present a case series of five patients with scar endometriosis, highlighting diverse clinical scenarios including typical cyclical pain, atypical non-cyclical presentation, recurrence following prior excision, and involvement of uncommon sites such as episiotomy scars. Most patients presented with a painful mass at the scar site, with symptoms often correlating with the menstrual cycle, although deviations from the classical presentation were observed. Imaging modalities such as ultrasonography and magnetic resonance imaging played an important role in preoperative evaluation; however, definitive diagnosis was established through histopathological examination in all cases. All patients underwent surgical excision with adequate margins, resulting in complete symptom resolution and no significant recurrence during follow-up. This case series emphasizes the importance of maintaining a high index of suspicion for scar endometriosis in women presenting with scar-related symptoms, even in atypical cases, and highlights surgical excision as the definitive and effective treatment modality.