Varied clinical presentations of scar endometriosis: case reports

Nidhi Gupta, Farhat Mazhari, Neha Varun, Reva Tripathi
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2018 · vol. 7(7) , pp. 2968 · doi:10.18203/2320-1770.ijrcog20182919 · W2811503185
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This paper describes two cases of scar endometriosis, one in a cesarean scar and another in an episiotomy scar, highlighting the varied presentations of this rare condition.

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The paper presents two case reports of scar endometriosis, specifically caesarean scar endometriosis and episiotomy scar endometriosis, in women who presented with pain and a tender mass with noted cyclical association with menstruation. The authors frame scar endometriosis as a rare complication following obstetric or gynecologic surgery, providing incidence estimates for both cesarean and episiotomy scars, and describe the “pathognomonic” symptom pattern in their presented cases. A key limitation is that the evidence comes from only two cases, without systematic data collection or comparison groups to quantify diagnostic performance or establish generalizable incidence for their setting. This paper is centrally about endometriosis — it focuses on clinically varied presentations of scar endometriosis after cesarean section and episiotomy.

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Abstract

Endometriosis is the second most prevalent benign gynaecological condition, in reproductive age women, defined as the presence of functioning endometrial tissue outside uterine cavity. Scar endometriosis is a rare entity with an incidence of 0.3-1% among reproductive age women following obstetric and gynaecologic surgeries. Complaints of pain, tender mass, cyclical association with menstrual cycle is almost pathognomonic. Here we present two case reports of scar endometriosis recently encountered at our institute – caesarean scar endometriosis and episiotomy scar endometriosis. The quoted episiotomy scar endometriosis incidence is about 0.06 - 0.07% while that of caesarean scar endometriosis is 0.03-0.4%.
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Varied clinical presentations of scar endometriosis: case reports DOI: https://doi.org/10.18203/2320-1770.ijrcog20182919Keywords: Caesarean section, Episiotomy, Scar endometriosisAbstract Endometriosis is the second most prevalent benign gynaecological condition, in reproductive age women, defined as the presence of functioning endometrial tissue outside uterine cavity. Scar endometriosis is a rare entity with an incidence of 0.3-1% among reproductive age women following obstetric and gynaecologic surgeries. Complaints of pain, tender mass, cyclical association with menstrual cycle is almost pathognomonic. Here we present two case reports of scar endometriosis recently encountered at our institute – caesarean scar endometriosis and episiotomy scar endometriosis. The quoted episiotomy scar endometriosis incidence is about 0.06 - 0.07% while that of caesarean scar endometriosis is 0.03-0.4%. Metrics References Vellido-Cotelo R, Muñoz-González JL, Oliver-Pérez MR, de la Hera-Lázaro C, Almansa-González C, Pérez-Sagaseta C et al. Endometriosis node in Gynaecologic scars: A study of 17 patients and the diagnostic considerations in clinical experience in tertiary care center. BMC Women’s Health (2015) 15:13, available at http://www.biomedcentral.com/content/ pdf/s12905-015-0170-9.pdf Rokitansky C. Ober Uterusdrusen-Neubildung in Uterus-und Ovarial-Sarcomen. Z GeeselechAerzte Wien 16:577-81, 1860, cited by Collines. American College of Obstetricians and Gynecologists. Practice bulletin no. 114: management of endometriosis. Obstet Gynecol. 2010;116(1):223-6. Demir M, Yildiz A, Ocal I, Yetimalar MH, Kilic D, Yavasi O. Endometriosis in episiotomy scar: a case report. J Cases Obstet Gynecol. 2014;1(1):8-10. Wolf Y, Haddad R, Werbin NY. Skornick, Kaplan O. Endometriosis in abdominal scars: adiagnosticpit fall. Am Surg. 1996;62(12)1042-44. de Gauna BR, Rodriguez D, Cabré S, Callejo J. A case of endometriosis in episiotomy scar with anal sphincter involvement. Int J Clin Med. 2011;2(05):624. Nominato NS, Prates LF, Lauar I, Morais J, Maia L, Geber S. Caesarean section greatly increases risk of scar endometriosis. Eur J Obstet Gynecol Rep Bio. 2010;152(1):83-5. Sasson IE, Taylor HS. Stem cells and the pathogenesis of endometriosis. Ann N Y Acad Sci. 2008;1127(1):106-15. Crum CP. The female genital tract. in Robbins Pathologic Basis of Disease, R. S. Cotran, V. Kumar, and V. Collins, Eds., Saunders, Philadelphia, Pa, USA, 6th edition, 1999. Gunes M, Kayikcioglu F, Ozturkoglu E, Haberal A. Incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures. J Obstetr Gynaecol Res. 2005;31(5):471-5. Rivlin ME, Das SK, Patel RB, Meeks GR. Leuprolide acetate in the management of cesarean scar endometriosis. Obstet Gynecol. 1995;85(5):838-9. Picod G, Boulanger L, Bounoua F, Leduc F, Duval G. Abdominal wall endometriosis after caesarean section: report of fifteen cases. Gynecol Obstet Fertilite. 2006;34(1):8-13.

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