Retrospective clinicopathological analysis of scar endometriosis and its surgical management

Kavitha Yogini Duraisamy, Devi Balasubramaniam, Karthikha Ravi, Aravinth Subramaniam
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2021 · vol. 10(2) , pp. 658 · doi:10.18203/2320-1770.ijrcog20210323 · W3128800308
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⚙ AI-generated summary by claude@2026-06, 2026-06-12 ⓘ

This retrospective study analyzed 28 scar endometriosis cases, finding a strong association with prior cesarean sections and cyclical pain, with wide local excision being the primary treatment.

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This retrospective clinicopathological study analyzed 28 patients with abdominal wall (scar) endometriosis diagnosed and surgically managed at a single hospital over 3 years, collecting demographics, prior uterine surgery, clinical and surgical findings, whether pelvic endometriosis was present on diagnostic laparoscopy, mesh use, and recurrence during follow-up. All patients had a history of prior caesarean surgery or hysterotomy, and the main clinical feature was cyclical pain; abdominal wall lesions were demonstrated in all cases by MRI or ultrasound, and histopathology confirmed endometriosis in every patient. Diagnostic laparoscopy was performed in 26 patients and showed associated pelvic endometriosis in 9, with lesion planes varying from subcutaneous to sheath to muscular. The authors note the rarity of scar endometriosis and describe MRI/USG and complete wide local excision as key elements, but the study’s single-center retrospective design and small sample limit generalizability. This paper is centrally about endometriosis — it specifically examines scar endometriosis in abdominal wall tissue and its surgical outcomes.

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Abstract

Background: Scar endometriosis is a rare form of extrapelvic endometriosis. It is defined as presence of endometrial glands and stroma in the abdominal wall. They have a variable clinical presentation and present to various doctors. Abdominal mass along with cyclical pain is pathognomic of scar endometriosis. Objective was to analyse the clinical presentation and surgical outcomes of scar endometriosis.Methods: It was a retrospective observational study. We have collected records of 28 patients of scar endometriosis managed at GEM Hospital over a period of 3 years. Patients demographic features, previous surgery, clinical findings, surgical findings, association with pelvic endometriosis as noted on diagnostic laparoscopy, need for mesh, recurrence rate on follow up were noted.Results: Mean age of patients was 32.1 years. History of previous caesarean surgery/hysterotomy was present in all patients. Major clinical presentation was cyclical pain. MRI or USG was done and abdominal wall lesions were demonstrated in all cases. Diagnostic laparoscopy was done in 26 of these patients and showed associated endometriosis in 9 patients. Plane of endometriosis was found to be subcutaneous for 9 cases, sheath in 7 and muscular in 12 cases. HPE was proven in all cases.Conclusions: Scar endometriosis is rare. High index of suspicion is needed for diagnosis, especially in cases of previous caesarean sections. MRI and USG are useful tools for diagnosis. Complete wide local excision of scar endometriosis is the primary modality of treatment. Diagnostic laparoscopy along with the procedure is helpful in diagnosing associated pelvic endometriosis.
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Background

Scar endometriosis is a rare form of extrapelvic endometriosis. It is defined as presence of endometrial glands and stroma in the abdominal wall. They have a variable clinical presentation and present to various doctors. Abdominal mass along with cyclical pain is pathognomic of scar endometriosis. Objective was to analyse the clinical presentation and surgical outcomes of scar endometriosis.

Methods

It was a retrospective observational study. We have collected records of 28 patients of scar endometriosis managed at GEM Hospital over a period of 3 years. Patients demographic features, previous surgery, clinical findings, surgical findings, association with pelvic endometriosis as noted on diagnostic laparoscopy, need for mesh, recurrence rate on follow up were noted.

Results

Mean age of patients was 32.1 years. History of previous caesarean surgery/hysterotomy was present in all patients. Major clinical presentation was cyclical pain. MRI or USG was done and abdominal wall lesions were demonstrated in all cases. Diagnostic laparoscopy was done in 26 of these patients and showed associated endometriosis in 9 patients. Plane of endometriosis was found to be subcutaneous for 9 cases, sheath in 7 and muscular in 12 cases. HPE was proven in all cases.

Conclusions

Scar endometriosis is rare. High index of suspicion is needed for diagnosis, especially in cases of previous caesarean sections. MRI and USG are useful tools for diagnosis. Complete wide local excision of scar endometriosis is the primary modality of treatment. Diagnostic laparoscopy along with the procedure is helpful in diagnosing associated pelvic endometriosis. Metrics

References

Rani PR, Soundararaghavan S, Rajaram P. Endometriosis in abdominal scars- review of 27 cases. Int J Gynaecol Obstet. 1991;36(3):215-8. Fazari A, Paulose L, Maqbool S, Malik Z, Raman L. Scar endometriosis- case report. Open J Obstet Gynecol. 2018;08(12):1205-9. Wolf G, Singh K. Cesarean scar endometriosis. Obstet Gynecol Survey. 1989;44(2):89-95. Steck W. Cutaneous endometriosis. JAMA. 1965;191(3):167. Horton JD, Dezee KJ, Ahnfeldt EP, Wagner M. Abdominal wall endometriosis: a surgeon’s perspective and review of 445 cases. Am J Surg. 2008;196(2):207-12. Scholefield HJ, Sajjad Y, Morgan PR. Cutaneous endometriosis and its association with caesarean section and gynaecological procedures. J Obstet Gynaecol. 2002;22(5):553-4.

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endometriosis

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