HIDDEN WITHIN THE SCAR: A CASE SERIES OF EPISIOTOMY SCAR ENDOMETRIOSIS

Dr. Mukku Sindhuja, Dr. Nithya R, R Nithya, Dr. Niveditha P, T. S. Meena
In: Genetics and Molecular Research · 2026 · doi:10.4238/f3q22375 · W7204480132
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This case series of three women with episiotomy scar endometriosis demonstrates that complete surgical excision leads to symptom resolution, highlighting the need for clinical awareness to diagnose this rare extrapelvic condition accurately.

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This case series examines episiotomy scar endometriosis, a rare extrapelvic condition where endometrial tissue implants into perineal wounds following vaginal delivery. The study reports on three women aged 29 to 35 who presented with cyclical perineal pain and swelling years after their initial deliveries, highlighting significant diagnostic delays due to symptoms mimicking other benign conditions like abscesses or hidradenoma papilliferum. Complete surgical excision successfully resolved symptoms in all patients, with histopathology confirming the presence of endometrial glands and stroma, although one case required muscle reconstruction due to deep infiltration. This paper is centrally about endometriosis — specifically focusing on the diagnosis and surgical management of extrapelvic lesions located within episiotomy scars.

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Abstract

Background: Episiotomy scar endometriosis is a rare form of extrapelvic endometriosis resulting from implantation of endometrial tissue into an episiotomy wound during vaginal delivery. Owing to its rarity and nonspecific presentation, diagnosis is frequently delayed or mistaken for other benign perineal conditions. Case Presentation: We report a case series of three women aged 29–35 years who presented 5–6 years after vaginal delivery. All patients complained of cyclical perineal pain associated with a palpable scar swelling that worsened during menstruation. Lesion sizes ranged from 2 × 1 cm to 4 × 3 cm. One patient was initially diagnosed with hidradenoma papilliferum, while another received repeated treatment for presumed recurrent perianal abscess, illustrating the diagnostic challenges associated with this condition. Ultrasonography was normal in one patient, whereas magnetic resonance imaging accurately demonstrated lesion extent in two patients, including deep bulbospongiosus muscle infiltration in one case. All patients underwent complete surgical excision, with perineal muscle reconstruction required in one patient. Histopathological examination confirmed the presence of endometrial glands and stroma in all cases. Postoperative recovery was uneventful, with complete symptom resolution and no recurrence during follow-up. Conclusion: Episiotomy scar endometriosis should be considered in every woman presenting with cyclical perineal pain and a previous history of episiotomy. Careful clinical evaluation, appropriate imaging for assessment of disease extent, complete surgical excision, and histopathological confirmation remain the cornerstone of successful management. This case series highlights the importance of increased clinical awareness to facilitate early diagnosis and avoid unnecessary delays in treatment.
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HIDDEN WITHIN THE SCAR: A CASE SERIES OF EPISIOTOMY SCAR ENDOMETRIOSIS DOI: https://doi.org/10.4238/f3q22375Keywords: Endometriosis; Episiotomy; Perineal scar; Scar endometriosis; Extrapelvic endometriosis; Surgical excisionAbstract Background: Episiotomy scar endometriosis is a rare form of extrapelvic endometriosis resulting from implantation of endometrial tissue into an episiotomy wound during vaginal delivery. Owing to its rarity and nonspecific presentation, diagnosis is frequently delayed or mistaken for other benign perineal conditions. Case Presentation: We report a case series of three women aged 29–35 years who presented 5–6 years after vaginal delivery. All patients complained of cyclical perineal pain associated with a palpable scar swelling that worsened during menstruation. Lesion sizes ranged from 2 × 1 cm to 4 × 3 cm. One patient was initially diagnosed with hidradenoma papilliferum, while another received repeated treatment for presumed recurrent perianal abscess, illustrating the diagnostic challenges associated with this condition. Ultrasonography was normal in one patient, whereas magnetic resonance imaging accurately demonstrated lesion extent in two patients, including deep bulbospongiosus muscle infiltration in one case. All patients underwent complete surgical excision, with perineal muscle reconstruction required in one patient. Histopathological examination confirmed the presence of endometrial glands and stroma in all cases. Postoperative recovery was uneventful, with complete symptom resolution and no recurrence during follow-up. Conclusion: Episiotomy scar endometriosis should be considered in every woman presenting with cyclical perineal pain and a previous history of episiotomy. Careful clinical evaluation, appropriate imaging for assessment of disease extent, complete surgical excision, and histopathological confirmation remain the cornerstone of successful management. This case series highlights the importance of increased clinical awareness to facilitate early diagnosis and avoid unnecessary delays in treatment. Downloads Published Issue Section License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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