Scar Endometriosis: Clinical Features, Diagnosis, and Surgical Management – A Case Series

Background: Scar endometriosis is a rare type of extrapelvic endometriosis in which functional endometrial tissue can be found in the operative scar or surrounding skin, developing most commonly following cesarean section. Its variable clinical presentation frequently leads to misdiagnosis and delays in management. We describe a case series of five patients with scar endometriosis including unique presentations such as cyclical pain, atypical non-cyclical presentation, non-surgical recurrence and points of joint scars such as episiotomy. Results: All patients had a painful mass of the scar site, and symptoms were frequently related to the menstrual cycle but other nonclassical presentations have been noted. Imaging modalities including ultrasonography and magnetic resonance imaging were important in preoperative evaluation, however histopathological diagnosis was confirmed in all cases. This postoperative course was followed by all patients who underwent surgical resection with adequate margins and experienced complete resolution of symptoms without significant relapse in follow-up. Conclusion: This case series emphasizes the need for a high index of suspicion for scar endometriosis in any female patient with symptoms associated with surgical scars and particularly, presents this entity even in atypical cases; it also confirms that surgical excision remains the gold standard treatment. Keywords: Scar endometriosis; Abdominal wall endometriosis; Cesarean section; Surgical scar; Case series; Extrapelvic endometriosis; Cyclical pain; Episiotomy scar; Surgical excision; Recurrence