A case series on management of scar endometriosis following C-sections

Tharun Ganapathy Chitrambalam, Sidhu Sekhar, Sakthivel Jeyakumar, Koshy Mathew Panicker
In: International Surgery Journal · 2019 · vol. 6(7) , pp. 2621 · doi:10.18203/2349-2902.isj20193008 · W2953687498
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⚙ AI-generated summary by claude@2026-06, 2026-06-11 ⓘ

This case series describes five patients with scar endometriosis following C-sections, often initially misdiagnosed, requiring surgical excision as medical treatment was ineffective.

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This case series reports 5 patients with scar endometriosis following cesarean section, describing how several cases were initially misdiagnosed as stitch granuloma. The authors discuss the condition’s pathogenesis, diagnosis, and management, noting that medical (hormonal) treatment was not helpful in these patients. All 5 patients ultimately required wide surgical excision of the lesion. This paper is centrally about endometriosis—specifically scar endometriosis arising in prior C-section surgical scars.

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Abstract

Endometriosis is presence of functioning endometrial tissue outside the uterine cavity. Endometriosis can sometimes occur in a previous surgical scar. Scar endometriosis is rare and difficult to diagnose. It mostly follows obstetrical and gynecological surgeries. This condition is often confused with other surgical conditions. We are reporting 5 cases of scar endometriosis following cesarean section, some of which were misdiagnosed as stitch granuloma initially. Medical treatment was not helpful. All 5 patients required wide surgical excision of the lesion. The pathogenesis, diagnosis and treatment of this condition are being discussed.
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A case series on management of scar endometriosis following C-sections DOI: https://doi.org/10.18203/2349-2902.isj20193008Keywords: Cesarean section, Hormonal therapy, Scar endometriosis, Wide local excisionAbstract Endometriosis is presence of functioning endometrial tissue outside the uterine cavity. Endometriosis can sometimes occur in a previous surgical scar. Scar endometriosis is rare and difficult to diagnose. It mostly follows obstetrical and gynecological surgeries. This condition is often confused with other surgical conditions. We are reporting 5 cases of scar endometriosis following cesarean section, some of which were misdiagnosed as stitch granuloma initially. Medical treatment was not helpful. All 5 patients required wide surgical excision of the lesion. The pathogenesis, diagnosis and treatment of this condition are being discussed. Metrics References Advincula A, Truong M, Lobo RA. Endometriosis: Etiology, Pathology, Diagnosis, Management. 7 ed. Comprehensive Gynaecology. Elsevier; 2019: 423-442. Allan Z. A case of endometriosis causing acute large bowel obstruction. Int J Surg Case Rep. 2018;42:247-9. 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. Cinardi N, Franco S, Centonze D, Giannone G. Perineal scar endometriosis ten years after Miles ’ procedure for rectal cancer : Case report and review of the literature. Int J Surg Case Rep. 2018;2(6):150-3. Hogg S. Endometriosis update. Obstet Gynaecol Reprod Med. 2018;28(3):61-9. Tran-harding K, Nair RT, Dawkins A, Ayoob A, Owen J, Deraney S, et al. Endometriosis revisited : an imaging review of the usual and unusual manifestations with pathological correlation. Clin Imaging. 2018;52(7):163-71. Marsden NJ. Scar endometriosis : A rare skin lesion presenting to the plastic surgeon. Br J Plast Surg. 2018;66(4):e111-3. Marques C, Silva TS, Dias MF. Gynecologic Oncology Reports Clear cell carcinoma arising from abdominal wall endometriosis – Brief report and review of the literature. Gynecol Oncol Reports. 2018;20(2017):78-80. Mubarak SA, Huang K-G, Adlan A-S. Laparoscopic view of abdominal wall endometrioma. Gynecol Minim Invasive Ther. 2016;5:33-5. Nominato NS, Prates LF, Lauar I, Morais J, Maia L, Geber S. Caesarean section greatly increases risk of scar endometriosis. Eur J Obstet Gynecol. 2018;152(1):83-5.

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