Perianal Endometriosis: An Uncommon Site for a Common Problem

Katie McComb, Mohammed Barghash, Saleh Eltayef
Cureus · 2023 · vol. 15(9) , pp. e44840 · doi:10.7759/cureus.44840 · PMID:37809144 · PMC10559834 · W4386498099
article OA: gold CC0 ⤵ 4 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-10 ⓘ

This case report describes a 37-year-old woman whose recurrent perineal pain and swelling, initially mistaken for scar tissue and then an abscess, was confirmed by histology to be rare perianal endometriosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This paper is a case report describing a 37-year-old woman with recurrent, cyclical perianal pain and swelling at the site of a prior episiotomy scar, assessed using serial MRI imaging, examination under anesthesia, incision and drainage, and eventual surgical excision with histology. The key findings were that the presumptive diagnoses based on imaging and clinical presentation (initially scar tissue, then likely chronic abscess) were incorrect, and histological analysis confirmed endometriosis in the dermis and subcutis with decidual change and acute inflammation. A major limitation explicitly emphasized in the report is the diagnostic difficulty, because perianal endometriosis can mimic abscesses and MRI/ultrasound interpretations can be inaccurate relative to surgical/histological confirmation. This paper is centrally about endometriosis — specifically perianal (extraperitoneal) endometriosis presenting at an episiotomy scar and masquerading as a perianal abscess.

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Abstract

Endometriosis is the presence of uterine glands and stroma outside of the uterus. It is highly prevalent in women of reproductive age. It is usually found in the pelvis, with most cases being found on the peritoneum, ovaries, or deep in the pelvis. Extraperitoneal endometriosis is uncommon. Perianal endometriosis has an incidence of only 0.2%. We present the case of a 37-year-old woman with recurrent pain and swelling in the perineum at the site of a previous episiotomy scar. Initial imaging and assessment determined this to be scar tissue. Following re-presentation, it was mistakenly diagnosed as a perianal abscess, and the patient underwent incision and drainage. The wound failed to heal with significant induration. Further assessment of the wound was undertaken under general anesthesia. An excision of the affected area was performed, with histological analysis confirming endometriosis. This case highlights that extra-peritoneal endometriosis is a rare but treatable cause of recurrent, cyclical pelvic pain and swelling in the perineum. A high index of clinical suspicion is required due to its ability to mimic other pathologies, including abscesses and cysts. The primary management of perianal endometriosis is surgical excision. Where complete excision is not possible, medical management with hormone therapy should be considered.

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endometriosis

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