Incisional Scar Endometriosis: A Case Series from a Tertiary Hospital in Odisha, India

Background: Endometriosis affects 5-10% of reproductive-aged women, with incisional scar endometriosis (ISE) being a rare extra-pelvic subtype, usually after Cesarean sections due to iatrogenic implantation.Rising Cesarean rates have led to more ISE cases, yet diagnosis remains challenging due to mimicking symptoms.This study presents a case series from a tertiary hospital in Odisha, India.Methods: A retrospective review was conducted of seven women (aged 23-43 years) who presented between 2015 and 2024 with abdominal wall masses and cyclical symptoms related to prior uterine surgery.All underwent clinical evaluation, imaging (USG and MRI where indicated), and fine-needle aspiration cytology (FNAC).Surgical excision was performed in each case, with histopathological confirmation.Results: All patients presented 2-7 years after prior surgery with a palpable scar mass and cyclical symptoms such as pain, bleeding, or discharge.Clinical features and mass sizes varied.FNAC was diagnostic in one case but inconclusive in another.USG findings were non-specific, whereas MRI provided a definitive preoperative diagnosis in two cases.Histopathology confirmed ISE in all cases.Wide local excision was curative in each patient, with one receiving preoperative leuprolide.Postoperative recovery was uneventful, and prognosis after complete excision is excellent, with recurrence rates reported between 4.3% and 15%.Conclusion: Scar endometriosis should be suspected in women with a surgical history presenting with cyclical scar symptoms.While FNAC and USG may be inconclusive, MRI offers superior diagnostic clarity, and histopathology remains the gold standard.Wide excision is the treatment of choice with low recurrence risk.