Foco endometriosico en cicatriz de Episiotomía. A propósito de un caso. Endometriosis

Endometriosis is a mystery because it has not been demonstrated why these cells are viable in the abdominal cavity. It is thought that the immune system is involved in implantation outside the uterine cavity by the abatement in the regulatory capacity of the natural killer cells of the peripheral and peritoneal immune cells. Among the diagnostic methods are ultrasound, antibodies, histological examination, laparoscopy and laparotomy. Here we present the case of a secundigesta patient with intense pain in the scar of the episiorrhaphy, as well as superficial dyspareunia. After one year of labor, she began with cyclical pain coinciding with menstruation in the area of episiotomy, so the midwife of her health center decided to refer her to the gynecology service of the reference specialty center. After a gynecological evaluation it was decided to perform a biopsy of the area and send the sample to pathological anatomy, the histological examination showed endometriosis of vulvar tissue. After informing the patient of the result, surgical treatment is carried out with resection of the area along with pharmacological treatment, to alleviate the pain and achieve an optimal result of the surgical treatment. Although the incidence of endometriosis is low, it is necessary to ensure the cleanliness of the episiotomy before surgical suturing, to reduce the likelihood of presenting the disorder. The advance in the knowledge of the physiopathological process will allow new therapeutic schemes to eliminate the endometrial residues, as well as to clarify the mechanism of ectopic implantation of the endometrial tissue