A case report of scar endometriosis with bladder endometriosis

A case report of scar endometriosis with bladder endometriosis DOI: https://doi.org/10.18203/2320-1770.ijrcog20223516Keywords: Scar endometriosis, Bladder endometriosis, Abdominal scars, Surgical management, Rare malignant changeAbstract Endometriosis is a common gynaecological condition which occurs in 10-15% women of reproductive age group. It can occur in pelvic and extra pelvic regions like urinary tract, abdominal wall, nervous tract, gastrointestinal tract, nose, lungs, umbilicus and sciatic nerve tract. Previous abdominal wall surgery can lead to scar endometriosis based on implantation theory which is very rare and this is hormone dependent. Here we are presenting a case of recurrent scar endometriosis along with bladder endometriosis which is extremely rare. The common cause for scar endometriosis is caesarean section and hysterotomy. Rarely it can occur following laparoscopy and amniocentesis. The diagnosis is based on the symptoms which are cyclical. USG and MRI can help in the pre-operative diagnosis and FNAC can confirm the diagnosis. Management of scar endometriosis is mainly wide excision of the lesion. Medical management can only be temporary. COCs, progesterone, dienogest and GnRH analogues are the drugs for medical management. Recurrence of scar endometriosis is also rare and association with bladder endometriosis is still rare. Malignant changes are almost less than 1%. This patient had scar endometriosis, bladder endometriosis and adenomyosis, fimbrial endometriosis and ovarian endometrioma. All were excised and post-operative suppression with GnRH was given for 3 months and LNG-IUS was inserted for prevention of recurrence as well as for management of adenomyosis. Metrics References Nahir B, Eldar-Geva T, Alberton J, Beller U. Symptomatic diaphragmatic endometriosis ten years after total abdominal hysterectomy. Obstet Gynecol. 2004;104(5 Pt 2):1149-51. Minaglia S, Mishell DR, Ballard CA. Incisional endometriomas after Cesarean section: a case series. J Reprod Med. 2007;52(7):630-4. Kumar RR. Spontaneous abdominal wall endometrioma: A case report. Int J Surg Case Rep. 2021;78:180-3. Kocher M, Hardie A, Schaefer A, McLaren T, Kovacs M. Cesarean-Section Scar Endometrioma: A Case Report and Review of the Literature. J Radiol Case Rep. 2017;11(12):16-26. Uzunçakmak C, Güldaş A, Ozçam H, Dinç K. Scar endometriosis: a case report of this uncommon entity and review of the literature. Case Rep Obstet Gynecol. 2013;2013:386783. Costa JEFR, Accetta I, Maia FJS, SÁ RAM. Abdominal wall endometriosis: experience of the General Surgery Service of the Antônio Pedro University Hospital of the Universidade Federal Fluminense. Rev Col Bras Cir. 2020;47:e20202544. Oliveira MA, Leon AC, Freire EC, Oliveira HC. Risk factors for abdominal scar endometriosis after obstetric hysterotomies: a case-control study. Acta Obstet Gynecol Scand. 2007;86(1):73-80. Gachabayov M, Horta R, Afanasyev D, Gilyazov T. Abdominal wall endometrioma: Our experience in Vladimir, Russia. Niger Med J. 2016;57(6):329-33. Pachori G, Sharma R, Sunaria RK, Bayla T. Scar endometriosis: Diagnosis by fine needle aspiration. J Cytol. 2015;32(1):65-7. Kinkel K, Frei KA, Balleyguier C, Chapron C. Diagnosis of endometriosis with imaging: a review. Eur Radiol. 2006;16(2):285-98. Makena D, Obura T, Mutiso S, Oindi F. Umbilical endometriosis: a case series. J Med Case Rep. 2020;14(1):142. Purbadi S, Purwoto G, Winarto H, Nuryanto KH, Scovani L, Sotarduga GE. Case report: Caesarean scar endometriosis - A rare entity. Int J Surg Case Rep. 2021;85:106204. Dragoumis K, Mikos T, Zafrakas M, Assimakopoulos E, Stamatopoulos P, Bontis J. Endometriotic uterocutaneous fistula after cesarean section. A case report. Gynecol Obstet Invest. 2004;57(2):90-2. Abeshouse BS, Abeshouse G. Endometriosis of the urinary tract: a review of the literature and a report of four cases of vesical endometriosis. J Int Coll Surg. 1960;34:43-63. Goodman JD, Macchia RJ, Macasaet MA, Schneider M. Endometriosis of the urinary bladder: sonographic findings. AJR Am J Roentgenol. 1980;135(3):625-6. Westney OL, Amundsen CL, McGuire EJ. Bladder endometriosis: conservative management. J Urol. 2000;163(6):1814-7. Fedele L, Bianchi S, Montefusco S, Frontino G, Carmignani L. A gonadotropin-releasing hormone agonist versus a continuous oral contraceptive pill in the treatment of bladder endometriosis. Fertil Steril. 2008;90(1):183-4. Takagi H, Matsunami K, Ichigo S, Imai A. Novel medical management of primary bladder endometriosis with dienogest: a case report. Clinical and Experimental Obstetrics & Gynecology. 2011;38(2):184-5.