A rare case of perineal endometriosis with anal sphincter involvement

B. Nandini Priyanka, Abha Kiran, Veena Ganju Malla
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2020 · vol. 9(3) , pp. 1268 · doi:10.18203/2320-1770.ijrcog20200912 · W3007171732
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes a 28-year-old woman with a diagnosis of perineal scar endometriosis, treated with wide local excision and recommended follow-up for recurrence.

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This paper reports a rare case of perineal scar endometriosis in a 28-year-old woman with pain and swelling near an episiotomy site that was associated with menstruation; the swelling was tender, erythematous, and slightly increased during menstruation. The authors describe that clinical diagnosis was made based on exam, with preoperative perineal ultrasound and MRI used for evaluation, and the mass was removed and sent for histopathology. They note that although diagnosis remains essentially clinical, wide local excision is presented as the treatment of choice with recommendation for follow-up for recurrence, and histopathology is obligatory to exclude rare malignant change. This paper is centrally about endometriosis — it specifically presents a rare perineal (episiotomy scar) endometriosis case with anal sphincter involvement.

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Abstract

Perineal endometriosis is a rare entity which can be explained by direct implantation of endometriotic cells over the fresh episiotomy wound and subsequent development of scar endometriosis. Perineal scar endometriosis incidence is reported to be 0.3% to 1%. 28 years old, P1L1, presented with pain and swelling near episiotomy site which is associated with menstruation. Examination during menstruation revealed swelling was tender, erythematous and slightly increased in size. Clinical diagnosis of scar endometriosis was made after clinical examination. Mass excised and sent for histopathological examination. Although diagnosis essentially remains clinical, preoperative evaluation with perineal ultrasound and MRI was performed. Wide local excision remains treatment of choice and follow up for recurrence is recommended. Histopathological examination is obligatory to exclude rare possibility of malignant changes.
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A rare case of perineal endometriosis with anal sphincter involvement DOI: https://doi.org/10.18203/2320-1770.ijrcog20200912Keywords: Dyspareunia, Dysmenorroea, Endometriosis, Perineal endometriosis, Scar endometriosis, Wide local excisionAbstract Perineal endometriosis is a rare entity which can be explained by direct implantation of endometriotic cells over the fresh episiotomy wound and subsequent development of scar endometriosis. Perineal scar endometriosis incidence is reported to be 0.3% to 1%. 28 years old, P1L1, presented with pain and swelling near episiotomy site which is associated with menstruation. Examination during menstruation revealed swelling was tender, erythematous and slightly increased in size. Clinical diagnosis of scar endometriosis was made after clinical examination. Mass excised and sent for histopathological examination. Although diagnosis essentially remains clinical, preoperative evaluation with perineal ultrasound and MRI was performed. Wide local excision remains treatment of choice and follow up for recurrence is recommended. Histopathological examination is obligatory to exclude rare possibility of malignant changes. Metrics References Gauna BRD, Rodriguez D, Cabre S, Callejo J. A Case of Endometriosis in episiotomy scar with anal sphincter involvement. Inter J Clin Med. 2011;2:624-6. Al-Jabri K. Endometriosis at caesarian section scar. OMJ. 2009;24:294-5. Laadioui M, Alaoui F, Jayi S, Bouguern H, Chaara H. L’endometriose perineale profonde surcicatriced’episiotomie: A propos d’un cas rare. Pan African Med J. 2013;16:112. Vinatier D, Orazi G, Cosson M, Dufour P. Theories of endometriosis. European Journal of Obstet Gynecol Reprod Biol. 2001;96(1):21-34. Andola US, Andola SK, Sanghvi KJ. FNAC diagnosis of Scar endometriosis: A report of 3 cases with review of literature. J Basic Clin Reprod Sci. 2012;1:62-4. Schoelefield HJ, Sajjad Y, Morgan PR (2002) Cutaneous endometriosis and its association with caesarean section and gynaecological procedures. J Obstet Gynaecol. 2002;22:553-4. Medeiros FC, Calvalcante DM. Fine needle aspiration cytology of scar endometriosis: A study of seven cases and literature review. Diagnos Cytopathol. 2011;39:18-21. Demir M, Yildiz A, Ocal I, Yetimalar MH, Kilic D. Endometriosis in episiotomy scar: A case report. J Cases Obstet Gynecol. 2014;1:8-10. Kang SK, Lee MW, Choi JH, Sung KJ, Moon KC. Cutaneous endometriosis: a combination of medical and surgical treatment. J Dermatolog Treat. 2002;13:189-92. Hitti IF, Glasberg SS, Lubicz S. Clear cell carcinoma arising in extraovarian endometriosis: Report of three cases and review of the literature. Gynecol Oncol. 1990;39:314-20. Jain D. Perineal scar endometriosis: a comparison of two cases. BMJ Case Rep. 2013;29:1.

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