Endometriomas: Two Case Reports and Review of Literature

Objective: Scar endometriosis may develop after pelvic operations, such as cesarean section, tubal ligation, hysterectomy, hysterotomy or secondary to obstetric or surgical trauma. Perineal endometriosis in episiotomy scar and endometriosis in post hysterectomy abdominal scar endometriosis are quite rare. This prompted us to demonstrate the proper diagnosis; management and prophylactic procedure of scar endometriosis. Study Design: In these case reports we present females of age 27 and 38 years with complaints of growth at episiotomy site and post hysterectomy abdominal scar since 2 and 1 years respectively. In first case there is previous history of normal delivery 4 years back with episiotomy. The mass was increasing in size with pain and itching over the area during menses. A diagnosis of ?foreign body granuloma, ?endometriosis was done. In second case there was history of abdominal hysterectomy 2 years back. The patient presented with sub-cutaneous lesion on the anterior abdominal wall. Diagnostic tools used included USG Abdomen, transvaginal and endorectal ultrasonography (USG), magnetic resonance imaging (MRI) and biopsy. The mass was wide-excised together with scars in both cases. The recovery was uneventful with excellent functional and esthetic results. The excised skin covered specimens measured 3.5x3cm and 5x4.5cm. Cut sections showed small cystic spaces. The microscopy revealed endometrial glands and stroma embedded in the fibrous scar tissue. Results: Six months after operation, women were asymptomatic and there was no evidence of recurrence. Conclusion: Diagnosis of scar endometriosis should involve detailed history taking and pelvic examination. The role of needle aspiration cytology still remains controversial. Several prophylactic procedures have been presented to prevent decidual contamination of the wound. Complete surgical excision including the adjacent fascia or skin is the proper treatment of scar endometriosis. Increasing awareness of this condition among doctors can help in early diagnosis and treatment with gratifying results