A series of caesarean scar endometriosis with literature review

Introduction: Scar endometriosis is a rare form of endometriosis that usually develops in the scar after obstetric or gynaecological surgeries. With the increasing caesarean section rates, the frequency of caesarean scar endometriosis (CSE) is expected to rise. The symptoms and signs of scar endometri¬osis may be ambiguous and hence remains under diagnosed and under reported. Aim and Objectives: To analyse the cases of CSE and to establish surgery as the mode of treatment. Materials and Methods: This study involves review of records of nine cases with a clinical diagnosis of caesarean scar endometriosis. Seven of them received surgical management while two chose medical management. Diagnosis was made by clinico-imaging and cyto-histopathology as applicable. Results: The mean age of patients is 30.5 years. All subjects had history of caesarean section; they presented with cyclical pain at the scar and dysmenorrhea (100%). Five (55.6%) subjects had a palpable lump. Seven/nine subjects received wide local excision whereas two opted medical therapy. Two subjects underwent hysterectomy, one in view of recurrence and the other a multiparous women with concurrent AUB. Three subjects were given postoperative medical management in view of margin positive histology. Conclusion: The medical therapy was aimed the symptoms and to suppress the lesion; preferred in smaller endometriomas, desirous of future child bearing and in margin positive postoperative cases. However, surgical excision, which is both diagnostic and curative, remains the most effective treatment for scar endometriosis.