Cesarean scar incisional endometriosis: a report of two cases and review of the literature

Murat Akbaş, Veli Mihmanlı, Aras Pektaş, Emine Paşmakoğlu, Servet Şişman
In: The Medical Journal of Okmeydanı Training and Research Hospital · 2015 · doi:10.5222/otd.2015.1000 · W2802784992
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Two cases of scar endometriosis presenting as painful abdominal wall masses diagnosed after cesarean delivery are reported, with a discussion of its epidemiology, diagnosis, pathogenesis, and treatment.

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This paper reports two cases of cesarean scar incisional endometriosis in patients presenting with a painful abdominal wall mass, diagnosed as endometriosis based on the clinical picture and discussion of diagnostic considerations. The authors review the literature on epidemiology, diagnosis, pathogenesis, and treatment, emphasizing that diagnosis can be difficult because scar endometriosis may be mistaken for entities such as suture granuloma, incisional hernia, lipoma, abscess, cyst, or foreign body. They note that a mass within an incisional scar accompanied by cyclic pain related to menses is nearly pathognomonic, and a major limitation implied by the case-report design is the lack of systematic evidence beyond the two reported patients. This paper is centrally about endometriosis — specifically cesarean scar incisional endometriosis presenting as a painful abdominal wall mass with cyclic menses-related pain.

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2Okmeydanı Training and Research Hospital, Pathology Department, Istanbul, Turkey Abstract Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. Endometriotic lesions can be detected in the scar tissue after laparatomy, laparascopy, amniosynthesis and episiotomy. Diagnosis of this disease is not easy because it can be mistaken for a suture granuloma, incisional hernia, lipoma, abcess, cyst or foreign body. However, a mass in a incisional scar with symptoms of cyclic pain related to menses is nearly pathognomonic. We report two cases, who admitted with painful abdominal wall mass and was diagnosed as scar endometriosis.The epidemiology, diagnosis, pathogenesis and treatment are discussed. 2Okmeydanı Eğitim Araştırma Hastanesi, Patoloji Kliniği, İstanbul Endometriozis endometrial dokunun uterus kavitesi dışında bulunması olarak tanımlanır. Laparatomi, laparaskopi, amniyosentez ve epizyotomi sonrası skar dokusunda endometriozis lezyonları saptanabilinmektedir. Sütür granulomu, insizyonel herni, lipom, abse, kist veya yabancı cisim ile karıştırıldığı için bu hastalığın tanısını koymak kolay değildir. Ancak, insizyon skarında adet döneminde ortaya çıkan siklik ağrının eşlik ettiği kitle bu hastalık için patognomonik sayılabilir. Batın duvarında ağrılı kitle şikayeti ile başvuran ve skar endometriozis tanısı alan iki olguyu sunuyoruz.Epidemiyoloji, tanı, patogenez ve tedavi tartışılmıştır.

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endometriosis

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