A classic case of caesarean scar endometriosis in 39-year-old women presenting with cyclical abdominal pain: a case report

A classic case of caesarean scar endometriosis in 39-year-old women presenting with cyclical abdominal pain: a case report DOI: https://doi.org/10.18203/2320-1770.ijrcog20262576Keywords: Scar endometriosis, Abdominal wall mass, Caesarean section, Surgical scar, Ectopic endometrial tissue, Cyclical abdominal pain, FNAC, Abdominal or pelvic surgeryAbstract Scar or incisional scar endometriosis is a rare but increasingly recognised complication following obstetric and gynaecological surgeries, particularly caesarean section and others, including hysterectomy and myomectomy. It is frequently misdiagnosed due to its nonspecific presentation, which often mimics abscesses, hernias, hematomas, granulomas or neoplasms. This case report outlines a case of a female aged 39 years who reported with complaints of abdominal pain related to the menstrual cycles and a palpable infra-umbilical mass years after caesarean delivery. Ultrasonography revealed a hypoechoic solid lesion with internal vascularity, and fine needle aspiration cytology was suggestive of scar endometriosis. The patient underwent complete surgical excision, and histopathology confirmed the diagnosis. The case highlights the importance of clinical suspicion when a patient presents with the classical triad, appropriate imaging, and histopathological confirmation in diagnosing scar endometriosis. Surgical excision remains the definitive treatment. Metrics References Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010;362(25):2389-98. DOI: https://doi.org/10.1056/NEJMcp1000274 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 Womens Health. 2019;19(1):14. DOI: https://doi.org/10.1186/s12905-019-0711-8 Al Hoshan MS, Shaikh AA. A classical case of cesarean scar endometriosis in a 35-year-old woman presenting with cyclical abdominal pain: a case report. Am J Case Rep. 2023;24:e940200. DOI: https://doi.org/10.12659/AJCR.940200 Poudel D, Acharya K, Dahal S, Adhikari A. A case of scar endometriosis in cesarean scar: a rare case report. Int J Surg Case Rep. 2022;101:107852. DOI: https://doi.org/10.1016/j.ijscr.2022.107852 Katwal S, Katuwal S, Bhandari S. Endometriosis in cesarean scars: a rare case report with clinical, imaging, and histopathological insights. SAGE Open Med Case Rep. 2023;11:2050313X231197009. DOI: https://doi.org/10.1177/2050313X231197009 Gruber TM, Lange K, Ebeling GS, Henrich W, Mechsner S. Scar endometriosis, a form of abdominal wall endometriosis: a neglected obstetrical complication? Arch Gynecol Obstet. 2025;312(1):1-8. DOI: https://doi.org/10.1007/s00404-024-07834-2 Safin M, Revathy S, Thanka J. Decidualised caesarean scar endometriosis in a gravid woman: A case report. J Clin Diagn Res. 2026;20(2):ED05-ED07. DOI: https://doi.org/10.7860/JCDR/2026/82036.22390 Arkoudis NA, Moschovaki-Zeiger O, Prountzos S, Spiliopoulos S, Kelekis N. Caesarean-section scar endometriosis (CSSE): clinical and imaging fundamentals of an underestimated entity. Clin Radiol. 2023;78(9):644-54. DOI: https://doi.org/10.1016/j.crad.2023.05.020 Buckingham M, Vissers G, Tsonis O, Pandey S. Surgical technique for excision of cesarean-scar endometriosis: approach and considerations. J Minim Invasive Gynecol. 2024;40(4):10. DOI: https://doi.org/10.1089/gyn.2023.0094 Mittal R, Ashraf A, Gupta M, Shah M. Scar endometriosis: the menace of surgery. J Surg Case Rep. 2023;2023(7):rjad413. DOI: https://doi.org/10.1093/jscr/rjad413