Scar endometriosis after caesarean section: a case series and review of literature

Sandeep Nanaware, Prajakta Shende, P.D. Gaikwad, Pradeep Gaikwad, Shalini Mahana Valecha
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2016 · pp. 948–952 · doi:10.18203/2320-1770.ijrcog20160847 · W2323322040
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⚙ AI-generated summary by claude@2026-07, 2026-07-08 ⓘ

This case series and literature review describes scar endometriosis, a rare condition mimicking other surgical issues, highlighting imaging and FNAC for diagnosis and wide excision as the preferred treatment.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This paper presents a case series on scar endometriosis after Caesarean section, along with a review of the literature, focusing on the rarity and diagnostic difficulty of endometriotic masses in surgical scars. Across reported cases, the authors describe that such lesions can be confused with other postoperative conditions, and they emphasize that imaging and fine-needle aspiration cytology are used toward improved diagnostic characterization; they note that medical treatment may be helpful in selected cases while wide excision is described as the treatment of choice. A major limitation is that the work is based on rare-case reporting and literature review rather than prospective evidence. Relevance to endometriosis: the entire report is about endometriosis occurring in Caesarean surgical scars (scar endometriosis) and draws attention to its diagnostic pitfalls and management as a distinct manifestation of endometriosis.

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Abstract

Endometriosis is defined as extra-uterine localization of ectopic functional endometrial gland and stroma. Cystic or solid tumoral masses caused by endometriosis are named as endometrioma. Although these pathologic conditions mostly encountered in ligaments of uterus, ovaries, pouch of douglos and pelvic peritoneum; endometriosis has also been reported in nose, breast, lung, spleen, gastrointestinal tract, kidney, abdominal wall, but scar endometriomais extremely rare. Scar endometriosis is rare and difficult to diagnose. This condition can be confused with other surgical conditions, however imaging techniques and FNAC are indicated towards better diagnostic approach. Medical treatment is helpful in selected cases but wide excision is the treatment of choice. By presenting this paper, and conducting a review of the literature, we intend to increase the awareness of this rather, rare condition.
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Scar endometriosis after caesarean section: a case series and review of literature DOI: https://doi.org/10.18203/2320-1770.ijrcog20160847Keywords: Endometriosis, Granuloma, Hemosiderin, Scar, LumpAbstract Endometriosis is defined as extra-uterine localization of ectopic functional endometrial gland and stroma. Cystic or solid tumoral masses caused by endometriosis are named as endometrioma. Although these pathologic conditions mostly encountered in ligaments of uterus, ovaries, pouch of douglos and pelvic peritoneum; endometriosis has also been reported in nose, breast, lung, spleen, gastrointestinal tract, kidney, abdominal wall, but scar endometriomais extremely rare. Scar endometriosis is rare and difficult to diagnose. This condition can be confused with other surgical conditions, however imaging techniques and FNAC are indicated towards better diagnostic approach. Medical treatment is helpful in selected cases but wide excision is the treatment of choice. By presenting this paper, and conducting a review of the literature, we intend to increase the awareness of this rather, rare condition.Metrics References Wheeler JM. Epidemiology and prevalence of endometriosis. Infertil Reprod Med Clin North Am. 1992;3:545-8. Jubanyik KJ, Comite F. Extrapelvic endometriosis. Obstet Gynecol Clin North Am. 1997;24:411-40. Taff L, Jones S. Cesarean scar endometriosis. A report of two cases. J Reprod Med. 2002;47:50-2. Apostolidis S, Michalopoulos A, Papavramidis TS, Papadopoulos VN, Paramythiotis D, Harlaftis N. Inguinal Endometriosis: Three cases and literature review. South Med J. 2009;102:206-7. Sataloff DM, LaVorgna KA, McFarland MM. Extrapelvic endometriosis presenting as a hernia: clinical reports and review of the literature. Surgery. 1989;105:109-12. Picod G, Boulanger L, Bounoua F, Leduc F, Duval G. Abdominal wall endometriosis after cesarean section: Report of fifteen cases. Gynecol Obstet Fertil. 2006;34:8-13. Wolf Y, Haddad R, Werbin N, Skornick Y, Kaplan O. Endometriosis in abdominal scars: A diagnostic pitfall. Am Surg. 1996;62:1042-4. Celik M, Bulbulogu E, Buyukbese MA, Cetinkaya A. Abdominal wall endometrioma :Localizing in rectus abdominus sheath. Turk j Med Sci. 2004;34;341-343 Chatterjee SK. Scar endometriosis: A clinico-pathological study of 17 cases. J Obstet Gynaecol. 1980;56:81-4. Koger KE, Shatney CH, Hodge K, McClenathan JH. Surgical scar endometrioma. Surg Gynecol Obstet. 1993;177:243-6. Aydin O. Scar endometriosis - A gynaecologic pathology often presented to the general surgeon rather than the gynaecologist: Report of two cases. Langenbecks Arch Sur.g 2007;392:105-9. Gunes M, Kayikcioglu F, Ozturkoglu E, Haberal A. Incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures.J Obstet Gynaecol Res. 2005;31:471-5. Nominato NS, Prates LF, Lauar I, Morais J, Geber S. Caesarean section greatly increases risk of scar endometriosis. Eur J Obstet Gynecol. 2010;152:83-5. Suginami H. A reappraisal of the coelomic metaplasia theory by reviewing endometriosis occurring in unusual sites and instances. Am J Obstet Gynecol. 1991;165:214-8. Ueki M. Histologic study of endometriosis and examination of lymphatic drainage in and from the uterus. Am J Obstet Gynecol. 1991;165:201-9. Mathur S, Peress MR, Williamson HO, Youmans CD, Maney SA, Garvin AJ, et al. Autoimmunity to endometrium and ovary in endometriosis. Clin Exp Immunol. 1982;50:259-66. Healy JT, Wilkinson NW, Sawyer M. Abdominal wall endometrioma in a laparoscopic trocar tract. Am Surg. 1995;61:962-3. Scott RB, Te Linde RW. Clinical external endometriosis; probable viability of menstrually shed fragments of endometrium. Obstet Gynecol. 1954;4:502-10. Seltzer VL, Benjamin F, Deutsch S. Perimenopausal bleeding patterns and pathologic findings. J Am Med Womens Assoc. 1990;45:132-4. Blanco RG, Parithivel VS, Shah AK, Gumbs MA, Scheinz M, Gerst PH. Abdominal wall endometriomas. Am J Surg. 2003;185:596-8. Sevdel AV, Sickle SJ, Warner EA, Sax HC. Extrapelvic endometriosis: Diagnosis and treatment. Am J Surg. 1993;177:243-6. Kinkel K, Frei KA, Balleyguier C, Chapron C. Diagnosis of endometriosis with imaging: A review. Eur Radiol. 2006;16:285-98. Meti S, Weiner JJ. Scar endometriosis: A diagnostic dilemma. Eur Clin Obstet Gynaecol 2006;2:62-4. Rivlin ME, Das SK, Patel RB, Meeks GR. Leuprolide acetate in the management of cesarean scar endometriosis. Obstet Gynecol. 1995;85:838-9. Sergent F, Baron M, Le Cornec JB, Scotte M, Mace P, Marpeau L. Malignant transformation of abdominal wall endometriosis: a new case report. J Gynecol Obstet Biol Reprod (Paris). 2006;35(2):186-90. Olejek A, Bichalski W, Rembielak-Stawecka B, Ziolkowski A. Adenocarcinoma arising from endometriosis in scar from a cesarean section treated with the use of plastic mesh. Ginekol Pol. 2004;75(10):797-801.

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