Symptomatology and Surgical Perspective of Scar Endometriosis: A Case Series of 16 Women

S Sumathy, Sudha Sumathy, Janu Mangalakanthi, Kishore Purushothaman, Deepti Sharma, Chithra Remadevi, Sarala Sreedhar
Journal of obstetrics and gynaecology of India · 2016 · vol. 67(3) , pp. 218–223 · doi:10.1007/s13224-016-0945-4 · PMID:28546671 · PMC5425637 · W2555891041
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-13 ⓘ

This retrospective review analyzed 16 women with scar endometriosis, finding it most commonly followed cesarean sections and presented with cyclical scar pain and swelling.

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This retrospective case series analyzed 16 women who underwent surgery for scar endometriosis at Amrita Institute of Medical Sciences over a 4-year period, focusing on symptomatology and surgical findings. Most patients reported cyclical pain and swelling at the scar site (93.8%), with the inciting surgery being caesarean section in 68.8%; 18.7% had port-site endometriosis, and 18.9% had concurrent pelvic endometriosis. All lesions involved subcutaneous tissue, with some extending to the rectus sheath, and there was no recurrence during an average follow-up of 11.91 months, though the authors also note that the roles of tumescent solution and postoperative medical management in preventing recurrence require further prospective studies. This paper is centrally about endometriosis — it describes symptom patterns and surgical management of scar endometriosis in women after cesarean or laparoscopic procedures.

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Abstract

Aim The prevalence of scar endometriosis is increasing with the increasing caesarean deliveries and laparoscopic procedures done for pelvic endometriosis. To analyse the symptomatology and surgical perspective of scar endometriosis.

Materials and methods

Retrospective review of 16 women who underwent surgery for scar endometriosis in the period of 4 years in Amrita institute of medical sciences.

Results

Mean age of the patients is 35.19 years. Mean interval from the index surgery to the presentation is 4.56 years. Mean size of the swelling is 2.84 cm. In 68.8% of the patients, caesarean section was the inciting surgery. 18.7% had port site endometriosis. Cyclical pain and swelling at the scar site was present in 93.8% of the women. 18.9% had concurrent pelvic endometriosis. All women had involvement of the subcutaneous tissue followed by 11 women with the involvement of rectus sheath. There was no recurrence of the lesion in the operated patients in the mean follow-up period of 11.91 months.

Conclusion

In all women presenting with cyclical scar site pain and swelling, scar endometriosis should be considered. It commonly follows caesarean section and laparoscopic surgeries done for endometriosis. Wide local excision with or without reconstruction is the method of choice for this condition. Role of tumescent solution during surgery and postoperative medical management to reduce recurrence needs further prospective studies. Similar content being viewed by others

References

Oh EM, Lee WS, Kang JM, et al. A Surgeon’s perspective of abdominal wall endometriosis at a caesarean section incision: nine cases in a single institution. Surg Res Pract. 2014;765372. (Epub 2014 Sep 22). Emre A, Akbulut S, Yilaz M, et al. Laparoscopic trocar port site endometriosis: a case report and brief literature review. Int Surg. 2012;97:135–9. Ding Y, Zhu J. A retrospective review of abdominal wall endometriosis in Shanghai, China. Int J Gynecol Obstet. 2013;121:41–4. Gidwaney R, Badler RL, Yam BL, et al. Endometriosis of abdominal and pelvic wall scars: multimodality imaging findings, pathologic correlation, and radiologic mimics. Radiographics. 2012;32(7):2031–43. doi:10.1148/rg.327125024. Pachori G, Sharma R, Sunaria R, et al. Scar endometriosis: diagnosis by fine needle aspiration. J Cytol. 2015;32(1):65–7. Zhao X, Lang J, Leng J, et al. Abdominal wall endometriomas. Int J Gynaecol Obstet. 2015;90:218–22. Bashir MM, Qayyum R, Saleem MH, et al. Effect of Time interval between tumescent local anesthesia infiltration and start of surgery on operative field visibility in hand surgery without tourniquet. J Hand Surg Am. 2015;40(8):1606–9. doi:10.1016/j.jhsa.2015.03.034 (Epub 2015 May 13). Ecker AM, Bonnellan NM, Shepherd JP, et al. Abdominal wall endometriosis: 12 years experience at a large academic institution. Am J Obstet Gynecol. 2014;211:363.e1-5. Khamechian T, Alizargar J, Mazoochi T. 5 year data analysis of patients following abdominal wall endometriosis surgery. BMC Womens Health. 2014;14:151. Zhang J, Liu X. Clinicopathological features of endometriosis in abdominal wall-clinical analysis of 151 cases. Clin Exp Obstet Gynecol. 2016;43(3):379–83. Uçar MG, Şanlıkan F, Göçmen A. Surgical treatment of scar endometriosis following cesarean section, a series of 12 cases. Indian J Surg. 2015;77(Suppl 2):S682–6. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest This is an original article based on a retrospective study performed at Amrita Institute of Medical Sciences, Kochi, Kerala, India. The authors, Sudha S, Janu Mangalakanthi, Kishore P, Deepti Sharma, Chitra Remadevi and Sarala Sreedhar declare that there is no conflict of interest related to this work. Informed Consent Informed consent has been taken from all patients and there are no ethical issues related to this study. Additional information Dr. Sudha Sumathy is a Clinical Professor in Department of Obstetrics and Gynaecology at Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham; Dr. Janu Mangalakanthi is a Clinical Associate Professor in Department of Obstetrics and Gynaecology at Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham; Dr. Kishore Purushothaman is a Clinical Associate Professor in Department of Plastic and Reconstructive Surgery at Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham; Dr. Deepti Sharma is a Clinical Professor in Department of Obstetrics and Gynaecology at Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham; Dr. Chithra Remadevi is a Clinical Associate professor in Department of Obstetrics and Gynaecology at Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham; Dr. Sarala Sreedhar is a Clinical Professor in Department of Obstetrics and Gynaecology at Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham. Electronic supplementary material Below is the link to the electronic supplementary material. Rights and permissions About this article Cite this article Sumathy, S., Mangalakanthi, J., Purushothaman, K. et al. Symptomatology and Surgical Perspective of Scar Endometriosis: A Case Series of 16 Women. J Obstet Gynecol India 67, 218–223 (2017). https://doi.org/10.1007/s13224-016-0945-4 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s13224-016-0945-4

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