Caesarean scar endometriosis: a rare site of extrapelvic endometriosis

Sipra Bagchi; Ashish Gupta; Kimmi Alwadhi; Shanti Sah

doi:10.18203/2320-1770.ijrcog20150768

Caesarean scar endometriosis: a rare site of extrapelvic endometriosis

Sipra Bagchi, Ashish Gupta, Kimmi Alwadhi, Shanti Sah

In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2015 · pp. 1639–1641 · doi:10.18203/2320-1770.ijrcog20150768 · W1764769598

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This case report discusses caesarean scar endometriosis, a rare extrapelvic endometriosis form, detailing its presentation, diagnosis with imaging, and treatment via wide local excision.

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This paper reviews and reports a case of caesarean scar endometriosis, described as a rare form of extrapelvic endometriosis most commonly occurring in a caesarean section scar. It characterizes the typical presentation as a palpable firm subcutaneous nodule near surgical scars with cyclic pain and swelling during menses, noting that these findings are frequently misdiagnosed as other scar- or abdominal wall-related conditions. The authors state that diagnosis relies mainly on clinical suspicion, with ultrasound with color Doppler able to “clinch” the diagnosis in typical cases, while FNAC may be inconclusive and MRI is described as the most sensitive but expensive modality. The paper concludes that wide local excision is the treatment of choice, while being based on a case report and discussion rather than a controlled study, and it is centrally about endometriosis — specifically caesarean scar endometriosis as an extrapelvic site.

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Abstract

Scar endometriosis is a rare presentation of extrapelvic endometriosis. A caesarean section scar is the most common site. The typical clinical presentation is that of a palpable firm subcutaneous nodule near surgical scars associated with cyclic pain and swelling during menses. It is often misdiagnosed with other abdominal wall and scar related pathological conditions. Diagnosis is mainly based upon a high index of suspicion. USG with color Doppler can clinch the diagnosis in patients with typical clinical features. FNAC may be inconclusive. MRI is the most sensitive but expensive modality to make the diagnosis. Wide local excision is the treatment of choice. We report a case of caesarean scar endometriosis and discuss about incidence, pathophysiology, diagnosis and treatment of this condition.

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Caesarean scar endometriosis: a rare site of extrapelvic endometriosis DOI: https://doi.org/10.18203/2320-1770.ijrcog20150768Keywords: Caesarean scar, Endometriosis, ExtrapelvicAbstract Scar endometriosis is a rare presentation of extrapelvic endometriosis. A caesarean section scar is the most common site. The typical clinical presentation is that of a palpable firm subcutaneous nodule near surgical scars associated with cyclic pain and swelling during menses. It is often misdiagnosed with other abdominal wall and scar related pathological conditions. Diagnosis is mainly based upon a high index of suspicion. USG with color Doppler can clinch the diagnosis in patients with typical clinical features. FNAC may be inconclusive. MRI is the most sensitive but expensive modality to make the diagnosis. Wide local excision is the treatment of choice. We report a case of caesarean scar endometriosis and discuss about incidence, pathophysiology, diagnosis and treatment of this condition. Metrics References Khalifa Al-Jabri Endometriosis at Caesarian Section Scar; Oman Med J. 2009;24(4):294–5. Iria Neri et.al. Diagnosis and Treatment of Post-caesarean Scar Endometriosis. Acta Dermato-Venereologica. Volume 87, Issue 5, Pages:428-429. Giampiero Francica, MD, et.al. Abdominal Wall Endometriomas near Cesarean Delivery Scars, Sonographic and Color Doppler Findings in a Series of 12 Patients Journal of Ultrasound in Medicine. 2003;22(10):1041-7. P Goel et.al. Cesarean scar endometriosis - Report of two cases. Indian journal of medical sciences. 2005;59(11):495-8. Dwivedi AJ, Agrawal SN, Silva YJ. Abdominal wall endometriomas. Dig Dis Sci. 2002;47:456–61. Pikoulis E. et al. Abdominal scar endometriosis after caesarean section: report of five cases. West Indian Med J. 2011;60(3).

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