The enigma of painful scars: abdominal and perineal scar endometriosis

Shagufta Bano, Shaheen Bano, Ashu Bhardwaj, Reetu Yadav, Shyam S. Leimapokpam
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2025 · vol. 14(5) , pp. 1614–1617 · doi:10.18203/2320-1770.ijrcog20251250 · W4409878381
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-28 ⓘ

This paper reports three cases of scar endometriosis, a rare condition where endometrial tissue implants in surgical scars, often delaying diagnosis and requiring wide excision.

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

This paper reports three clinical cases of abdominal and perineal scar endometriosis, a rare extra-pelvic form occurring in surgical scars after obstetric or gynecologic procedures, most often caesarean section. Across the cases, the authors discuss proposed pathogenesis via iatrogenic implantation of endometrial tissue into the wound, note that the condition is frequently mistaken for other dermatologic or surgical problems resulting in delayed diagnosis, and describe management that involved wide surgical excision of the lesions. The main limitation is that the evidence presented is limited to a small number of cases without broader comparative analysis. This paper is centrally about endometriosis — specifically painful abdominal and perineal scar endometriosis following surgical procedures.

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Abstract

Scar endometriosis is a rare and often underdiagnosed form of extra-pelvic endometriosis, occurring in surgical scars following obstetric and gynaecologic procedures. It is most commonly associated with caesarean sections but has also been reported after hysterectomies, episiotomies, and laparoscopic surgeries. The condition arises due to the iatrogenic implantation of endometrial tissue into the surgical wound, where it subsequently proliferates under hormonal influence. It is often mistaken for other dermatological or surgical conditions, leading to a delayed diagnosis. We are reporting three cases of scar endometriosis. The patient required wide surgical excision of the lesion. The pathogenesis, diagnosis, and treatment of this rare condition are being discussed.
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The enigma of painful scars: abdominal and perineal scar endometriosis DOI: https://doi.org/10.18203/2320-1770.ijrcog20251250Keywords: Endometriosis, Scar, Caesarean sectionAbstract Scar endometriosis is a rare and often underdiagnosed form of extra-pelvic endometriosis, occurring in surgical scars following obstetric and gynaecologic procedures. It is most commonly associated with caesarean sections but has also been reported after hysterectomies, episiotomies, and laparoscopic surgeries. The condition arises due to the iatrogenic implantation of endometrial tissue into the surgical wound, where it subsequently proliferates under hormonal influence. It is often mistaken for other dermatological or surgical conditions, leading to a delayed diagnosis. We are reporting three cases of scar endometriosis. The patient required wide surgical excision of the lesion. The pathogenesis, diagnosis, and treatment of this rare condition are being discussed. Metrics References Zhang P, Sun Y, Zhang C, Yeping Y, Linna Z, Ningling W, et al. Cesarean scar endometriosis: presentation of 198 cases and literature review. BMC Women's Health. 2019;19(1):14. DOI: https://doi.org/10.1186/s12905-019-0711-8 Malutan AM, Simon I, Ciortea R, Mocan-Hognogi RF, Dudea M, Mihu D. Surgical scar endometriosis: a series of 14 patients and brief review of literature. Clujul Med. 2017;90(4):411-5. DOI: https://doi.org/10.15386/cjmed-743 Nepali R, Upadhyaya Kafle S, Pradhan T, Dhamala JN, Scar endometriosis: A rare cause of abdominal pain. Dermatopathology. 2022;9(2):158-63. DOI: https://doi.org/10.3390/dermatopathology9020020 Kaplanoglu M, Kaplanoğlu DK, Dincer Ata C, Buyukkurt S, Obstetric scar endometriosis: Retrospective study on 19 cases and review of the literature: Int Sch Res Notices. 2014;417042. DOI: https://doi.org/10.1155/2014/417042 Akbulut S, Mahsuni Sevinc M, Bakir S, Cakabay B, Sezgin A. Scar Endometriosis in the Abdominal Wall: a Predictable Condition for Experienced Surgeons. Acta Chirurgica Belgica. 2010;110(3):303-7. DOI: https://doi.org/10.1080/00015458.2010.11680621 Horton JD, Kent JD, Eric PA, Michel W. Abdominal wall endometriosis: A surgeon's perspective and review of 445 cases. Am J Surg. 2008;196(2):207-12. DOI: https://doi.org/10.1016/j.amjsurg.2007.07.035 Ding Y, Zhu J. A retrospective review of abdominal wall endometriosis in Shanghai, China. Int J Gynaecol Obstet. 2013;121(1):41-4. DOI: https://doi.org/10.1016/j.ijgo.2012.11.011 Kim SJ, Choi SH, Won S. Cumulative recurrence rate and risk factors for recurrent abdominal wall endometriosis after surgical treatment in a single institution. Yonsei Med J. 2022;63:446-51. DOI: https://doi.org/10.3349/ymj.2022.63.5.446 Nigam A, Saxena P, Barla P, Pathak P. Scar endometriosis: the menache of surgery. BMJ Case Rep. 2014;206693:bcr2014206693. DOI: https://doi.org/10.1136/bcr-2014-206693

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endometriosis

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