Scar endometriosis

BACKGROUND: Scar endometriosis may develop after pelvic operations, such as cesarean section, tubal ligation, hysterotomy and hysterectomy. This prompted us to demonstrate the proper diagnosis; management and prophylactic procedure of scar endometriosis. METHODS: Twelve patients with scar endometriosis were diagnosed by clinical symptoms and signs, including a painful scar mass related to the menstrual cycle and cyclic bleeding from scars. Preoperative ultrasound needle aspiration cytology was arranged in three patients without painful mass. The management comprised complete surgical excision and selective medical treatment. Postoperative follow-up was scheduled at six-month intervals. RESULTS: Except for two patients who complained of scar pain but no palpable mass during menstruation, there was no evidence of recurrence in the other 10 patients. CONCLUSIONS: Diagnosis of scar endometriosis should involve detailed history taking and pelvic examination. Concerning the role of needle aspiration cytology, it still remains controversial. Several prophylactic procedures have been presented to prevent decidual contamination of the wound. Complete surgical excision including the adjacent fascia or skin is the proper treatment of scar endometriosis.