Scar endometriosis: a case report

Poonam Nain, Kalpana Mehta, Anjali Arun, Asmita Arun, Pragya Jain
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2025 · vol. 14(9) , pp. 3169–3172 · doi:10.18203/2320-1770.ijrcog20252764 · W4413800708
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes a 34-year-old multipara presenting with cyclic pain, a mass, and bloody discharge from her caesarean scar, confirmed as scar endometriosis by MRI and histopathology.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This paper is a case report of a 34-year-old multipar with a painful left lower abdominal mass and bloody discharge that increased with menstruation for 5 years after a prior caesarean section, with symptom recurrence 6 months after lumpectomy 18 months earlier. Clinical examination identified a 4×5 cm bluish firm immobile mass at the caesarean scar, and MRI showed a 37×42×45 mm lesion involving the rectus abdominis muscle, subcutaneous tissue, and skin at the prior surgical site. The patient underwent surgery, and histopathology confirmed scar endometriosis, which the authors note is rare and can be misdiagnosed as a lump, with diagnosis relying on clinical suspicion plus radiology and histopathology. This paper is centrally about endometriosis — it reports and confirms caesarean scar endometriosis.

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Abstract

Caesarean scar endometriosis is most commonly reported type of abdominal wall endometriosis due to is pathophysiology where endometrial tissue from caesarean incision directly implanted to the scar. A case report of a patient with a troublesome scar after caesarean section is presented below. A 34-year-old multipara with history of caesarean section delivery presented with complain pain, mass and bloody discharge from mass which increases during menstruation since past 5 years with history of lumpectomy 18 months ago with recurrence of symptoms 6 months after lumpectomy. On examination there was a 4×5 cm size, bluish firm, immobile mass at left size of caesarean scar. MRI suggested lesion measures 37×42×45 mm at the paramedian aspect of anterior pelvic wall involving rectus abdominis muscle, subcutaneous tissue and skin at site of previous surgical scar. Patient was operated and histopathological examination confirms diagnosis of scar endometriosis. Scar endometriosis is a rare entity which can easily be misdiagnosed as lump but the cyclic nature of pain with or without discharge from lump in a female patient with history of caesarean section should raise the suspicion of scar endometriosis. Caesarean scar endometriosis has a reported incidence of 0.03 to 0.45%. Diagnosis is mainly clinical after ruling out other conditions and diagnosis can be confirmed with radiology imaging and histopathology. Caesarean scar endometriosis should be considered in a reproductive age group patient with previous caesarean delivery which present with complain of lower abdominal pain.
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Scar endometriosis: a case report DOI: https://doi.org/10.18203/2320-1770.ijrcog20252764Keywords: Endometriosis, Scar endometriosis, Lower abdominal lump, Caesarean scarAbstract Caesarean scar endometriosis is most commonly reported type of abdominal wall endometriosis due to is pathophysiology where endometrial tissue from caesarean incision directly implanted to the scar. A case report of a patient with a troublesome scar after caesarean section is presented below. A 34-year-old multipara with history of caesarean section delivery presented with complain pain, mass and bloody discharge from mass which increases during menstruation since past 5 years with history of lumpectomy 18 months ago with recurrence of symptoms 6 months after lumpectomy. On examination there was a 4×5 cm size, bluish firm, immobile mass at left size of caesarean scar. MRI suggested lesion measures 37×42×45 mm at the paramedian aspect of anterior pelvic wall involving rectus abdominis muscle, subcutaneous tissue and skin at site of previous surgical scar. Patient was operated and histopathological examination confirms diagnosis of scar endometriosis. Scar endometriosis is a rare entity which can easily be misdiagnosed as lump but the cyclic nature of pain with or without discharge from lump in a female patient with history of caesarean section should raise the suspicion of scar endometriosis. Caesarean scar endometriosis has a reported incidence of 0.03 to 0.45%. Diagnosis is mainly clinical after ruling out other conditions and diagnosis can be confirmed with radiology imaging and histopathology. Caesarean scar endometriosis should be considered in a reproductive age group patient with previous caesarean delivery which present with complain of lower abdominal pain. Metrics References Danielpour PJ, Layke JC, Durie N, Glickman LT. Scar endometriosis-a rare cause for a painful scar: A case report and review of the literature. Can J Plast Surg. 2010;18(1):19. DOI: https://doi.org/10.4172/plastic-surgery.1000633 Fouad Messawa M, Yousef Omar S, Babagi RA, Endometriosis in Saudi Arabia; Prevalence, presentation, complications, and updated management: Simple Systematic Review. Int J Pharmaceut Phytopharmacol Res. 2020;10(5):36-42. Nepali R, Upadhyaya Kafle S, Pradhan T, Dhamala JN, Scar endometriosis: A rare cause of abdominal pain. Dermatopathol. 2022;9(2);158-63. DOI: https://doi.org/10.3390/dermatopathology9020020 Minaglia S, Mishell DR, Ballard C. A Incisional endometriomas after caesarean section: a case series. J Reprod Med. 2007;52(7):630-4. Zhang J, Liu X. Clinicopathological features of endometriosis in abdominal wall–clinical analysis of 151 cases. Clin Exp Obstet Gynecol. 2016;43(3):379-38. DOI: https://doi.org/10.12891/ceog2126.2016 Gonzalez RH, Singh MS, Hamza SA, Cutaneous endometriosis: A case report and review of the literature: Am J Case Rep. 2021;22:932493. DOI: https://doi.org/10.12659/AJCR.932493 Nominato NS, Prates LFVS, Lauar I. Caesarean section greatly increases 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 Purbadi S, Gatot P, Hariyono W, Kartiwa HN, Laurensia S, Gilbert ES. Case report: Caesarean scar endometriosis-A rare entity. Int J Surg Case Rep. 2021;85:106204. DOI: https://doi.org/10.1016/j.ijscr.2021.106204 Kinkel K, Frei KA, Balleyguier C, Chapron C. Diagnosis of endometriosis with imaging: a review. Eur Radiol. 2006;16(2):285-98. DOI: https://doi.org/10.1007/s00330-005-2882-y Cherrabi F, Moukit M, Kouach J, Rahali DM, Dehayni M. Caesarean scar endometriosis: a case report. Int J Reprod Contracept Obstet Gynecol. 2018;7(3):1221. DOI: https://doi.org/10.18203/2320-1770.ijrcog20180922

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