Chronic Cesarean Scar Abscess Mimicking Scar Endometriosis: A Diagnostic Pitfall

Emel Ozalp
In: Case Reports in Clinical Practice · 2026 · doi:10.18502/crcp.v10i6.21616 · W7162855236
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-04 ⓘ

A chronic cesarean scar abscess mimicking scar endometriosis in a 33-year-old woman was diagnosed intraoperatively after imaging suggested endometriosis, highlighting the diagnostic limitations of non-invasive methods for these lesions.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-04 · read from full text ⓘ

This case report describes a 33-year-old woman with chronic pelvic pain and abnormal uterine bleeding after three cesarean sections, evaluated with transvaginal ultrasonography and non-contrast MRI for a cesarean scar lesion suspected to be scar endometriosis. Imaging suggested scar endometriosis and surgery was planned, but intraoperative exploration revealed a cystic lesion under the bladder peritoneum containing purulent material, and complete excision was performed. Histopathology confirmed an abscess with no evidence of endometriosis, highlighting that imaging can be limited in distinguishing cesarean scar lesions and that discordant laboratory findings or inconclusive imaging should broaden the differential. This paper is centrally about endometriosis — it presents a diagnostic pitfall where an abscess mimicked scar endometriosis in a cesarean scar.

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Abstract

Cesarean scar–related masses represent a diagnostic challenge due to overlapping clinical and imaging features. Scar endometriosis is often the leading consideration; however, other entities may closely mimic its presentation. We report the case of a 33-year-old woman with a history of three cesarean sections presenting with chronic pelvic pain and abnormal uterine bleeding. Imaging studies, including transvaginal ultrasonography and non-contrast magnetic resonance imaging (MRI), revealed a lesion at the cesarean scar highly suggestive of scar endometriosis. Based on these findings, surgical intervention was planned. Intraoperative exploration demonstrated a cystic lesion beneath the bladder peritoneum containing purulent material. Complete excision was performed. Histopathological examination confirmed abscess formation with no evidence of endometriosis. This case highlights the limitations of imaging in differentiating cesarean scar lesions and emphasizes the importance of considering chronic abscess in the differential diagnosis, particularly when laboratory findings are discordant or imaging is inconclusive. Surgical exploration remains essential for definitive diagnosis and management.
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