Scar endometriosis: a rare case report

Hetvi Somaiya, Tushar Palve, Rajashree Thatikonda, Ankita Kumari
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2024 · vol. 13(10) , pp. 2936–2939 · doi:10.18203/2320-1770.ijrcog20242837 · W4402879009
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This case report describes a 30-year-old female with scar endometriosis following caesarean section, highlighting the diagnostic challenge of distinguishing it from malignancy and emphasizing the need for multidisciplinary management.

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This case report describes a thirty-year-old female presenting with scar endometriosis, an uncommon manifestation where endometrial tissue implants within the abdominal wall following a caesarean section. The authors highlight that accurate diagnosis requires a combination of clinical evaluation, imaging studies, and histopathological examination to distinguish the condition from other pathologies such as malignancy. They emphasize that multidisciplinary approaches and surgical intervention are crucial for effective management, symptom resolution, and preventing recurrence in patients with post-surgical abdominal wall masses. This paper is centrally about endometriosis — specifically focusing on the rare presentation of extra-pelvic scar endometriosis and its diagnostic and surgical management challenges.

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Abstract

Endometriosis is a challenging topic in gynaecology, and its diagnosis necessitates a high level of suspicion, particularly when it presents at extra-pelvic sites. Extra-pelvic endometriosis, though relatively rare, can manifest in various forms, with cutaneous endometriosis being the most common. Scar endometriosis is an uncommon manifestation of endometriosis where endometrial tissue is located within the abdominal wall following a caesarean section. This case report details a 30-year-old female with scar endometriosis and reviews the current literature on its management. Scar endometriosis often poses a diagnostic challenge due to its ability to mimic other conditions, including malignancy. Accurate diagnosis requires a combination of clinical evaluation, imaging studies, and histopathological examination. Multidisciplinary approaches are crucial for effective management. This case underscores the importance of considering scar endometriosis in patients with post-caesarean section abdominal wall masses. A thorough diagnostic workup and surgical intervention are key to resolving symptoms and preventing recurrence.
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Scar endometriosis: a rare case report DOI: https://doi.org/10.18203/2320-1770.ijrcog20242837Keywords: Scar endometriosis, Caesarean section, Abdominal wall, Case report, Surgical management, Differential diagnosisAbstract Endometriosis is a challenging topic in gynaecology, and its diagnosis necessitates a high level of suspicion, particularly when it presents at extra-pelvic sites. Extra-pelvic endometriosis, though relatively rare, can manifest in various forms, with cutaneous endometriosis being the most common. Scar endometriosis is an uncommon manifestation of endometriosis where endometrial tissue is located within the abdominal wall following a caesarean section. This case report details a 30-year-old female with scar endometriosis and reviews the current literature on its management. Scar endometriosis often poses a diagnostic challenge due to its ability to mimic other conditions, including malignancy. Accurate diagnosis requires a combination of clinical evaluation, imaging studies, and histopathological examination. Multidisciplinary approaches are crucial for effective management. This case underscores the importance of considering scar endometriosis in patients with post-caesarean section abdominal wall masses. A thorough diagnostic workup and surgical intervention are key to resolving symptoms and preventing recurrence. Metrics References Jan AJ, Hensen AC. Van Breda Vriesman, Julien BCM. Polyare: abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography. AJR Am J Roentgenol 2006;186:616-20. Von RC: Ueber uterusdrusen-neubuildung in uterus and ovarilsarcomen. ZGes Aerzte Wein. 37;577:1860. Ilker Sengul, MD, Demet Sengul MD, Serkan Kahyaoglu, MD, Inci Kahyaoglu, MD. Incisional endometriosis: a report of 3 cases. Can J Surg. 2009;52:444-5. Teng CC, Yang HM, Chen KF, Yang CJ, Chen LS, Kuo CL. Abdominal wall endometriosis: an overlooked but possibly preventable complication. Taiwan J Obstet Gynecol. 2008;47:42-8. Liand CC, Liou B, Tsai CC, et al. Scar endometriosis. Int Surg. 1998;83:69-71. Douglas C, Rotimi O. Extragenital endometriosis--a clinicopathological review of a Glasgow hospital experience with case illustrations. J Obstet Gynaecol. 2004;24:804-8. Chiang DT, Teh WT. Cutaneous endometriosis. Surgical presentations of a gynaecological condition: Aust Fam Physician. 2006;35:887-8. Gunes M, Kayikcioglu F, Ozturkoglu E, Haberal A. Incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures: J Obstet Gynaecol Res. 2005;31:471-5. Madsen H, Hansen P, Andersen OP. Endometrioid carcinoma in an operation, scar: Acta Obstet Gynecol Scand. 1980;59:475-6. Kocakusak A, Arpinar E, Arikan S, Demirbag N, Tarlaci A, Kabaca C. Abdominal wall endometriosis: a diagnostic dilemma for surgeons: Med Princ Pract. 2005;14:434-7. Chatterjee SK. Scar endometriosis: A clinicopathologic study of 17 cases. Obstet Gynecol. 1980;56:81-4. Ergün T, Lakadamyalı H. A rare cause of low abdominal pain: Abdominal wall endometriosis following caesarian section performed 13 years ago: Case Report. Turkiye Klinikleri J Gynecol Obst 2009;19:172-4. Balkawade NU, Madkar CS, Deshpande HG, Gosavi KA. Cesarean scar endometriosis: a rare case report. Ind J Obst Gynae. 2015;2(1):36-8. Danielpour PJ, Layke JC, Durie N, Glickman LT. Scar endometriosis-a rare cause for a painful scar: A case report and review of the literature. Can J Plast Surg. 2010;18(1):19-20. Katwal S, Katuwal S, Bhandari S. Endometriosis in cesarean scars: A rare case report with clinical, imaging, and histopathological insights” by SAGE Open Med Case Rep. 2023;11:212. Shaikh AA, Hoshan AS. A classic case of cesarean scar endometriosis in a 35-year-old woman presenting with cyclical abdominal pain: A Case Report. Am J Case Rep. 2023;24:940200.

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