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This case report describes a forty-year-old woman who developed a four-and-a-half-centimeter mass in her abdominal wall scar one year following a second cesarean section. The patient presented with the classic triad of a palpable tumor, cyclic pain correlated with menstruation, and a history of uterine surgery, leading to an initial misdiagnosis of granuloma. After hormonal therapy failed to alleviate symptoms, surgical excision was performed, and histopathological examination confirmed the presence of endometrial glands and stroma within the scar tissue. The authors conclude that endometriosis should be considered in patients with post-surgical scars exhibiting cyclic pain and masses, noting that complete surgical removal is an effective treatment. This paper is centrally about endometriosis — specifically, the presentation and management of endometriosis occurring in a cesarean section surgical scar.
Abstract
INTRODUCTION: Endometriosis is the presence of endometrial glands and stroma outside of uterine cavity. It may occur in the abdominal wall scar after the operation in which uterus was opened. In cesarean section scar it occurs in 0.4%. It is in 2/3 patients characterised with triad of: tumor, periodic pain associated with menses and history of cesarean section. The mechanism of endometriosis occuring in the cesarean scar is felt to be secondary to iatrogenic transplantation of endometrium or extrauterine decidual tissue into the incision during the cesarean section. CASE OUTLINE: Forty years old patient with tumor 4,5x4 cm that appeared in abdominal wall scar one year after second cesarean section, followed by periodic pain and macroscopic changes associated with menses. First diagnosis was granuloma in the surgical scar, but as she had periodic simptoms, diferential diagnosis was endometriosis. Hormonal therapy with contraceptiv drugs was ordered. As it was no improvement she was operated. The surgical excision of the tumor including fascia and muscle tissue was done. Sample revealed endometrium after histopathologic examination. Patient was complitely recoverd and without relepse of simptoms during followup to date. CONCLUSION: When there is a tumor in the cesarean section scar or scar after the operation in which uterus or ovarial tube was opened, followed with periodical pain and macroscopic changes associated with menses, endometriosis should be considered. Surgical excision of the tumor is sufficient and patohistological examination confirms diagnosis.
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Acta chirurgica Iugoslavica 2007 Volume 54, Issue 2, Pages: 79-81 Endometriosis in cesarean section surgical scar Stefanović D. (Institut za bolesti digestivnog sistema Kliničkog centra Srbije, Beograd) Introduction: Endometriosis is the presence of endometrial glands and stroma outside of uterine cavity. It may occur in the abdominal wall scar after the operation in which uterus was opened. In cesarean section scar it occurs in 0.4%. It is in 2/3 patients characterized with triad of: tumor, periodic pain associated with menses and history of cesarean section. The mechanism of endometriosis occurring in the cesarean scar is felt to be secondary to iatrogenic transplantation of endometrium or extrauterine decidual tissue into the incision during the cesarean section. Case outline. Forty years old patient with tumor 4,5x4 cm that appeared in abdominal wall scar one year after second cesarean section, followed by periodic pain and macroscopic changes associated with menses. First diagnosis was granuloma in the surgical scar, but as she had periodic symptoms, diferential diagnosis was endometriosis. Hormonal therapy with contraceptive drugs was ordered. As it was no improvement she was operated. The surgical excision of the tumor including fascia and muscle tissue was done. Sample revealed endometrium after histopathologic examination. Patient was completely recovered and without relapse of symptoms during follow up to date. Conclusion. When there is a tumor in the cesarean section scar or scar after the operation in which uterus or ovarial tube was opened, followed with periodical pain and macroscopic changes associated with menses, endometriosis should be considered. Surgical excision of the tumor is sufficient and patohistological examination confirms diagnosis. . Keywords: endometriosis, cesarean section surgicalscar, tumor
https://doi.org/10.2298/ACI0702079S
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Cited by
Kerkez M. (Institut za bolesti digestivnog sistema Kliničkog centra Srbije, Beograd)
Đorđević Z. (Institut za bolesti digestivnog sistema Kliničkog centra Srbije, Beograd)
Knežević S. (Institut za bolesti digestivnog sistema Kliničkog centra Srbije, Beograd)
Marković Lj. (Institut za patološku fiziologiju MF, Beograd)
Knežević Đ. (Institut za bolesti digestivnog sistema Kliničkog centra Srbije, Beograd)
Palibrk I. (Institut za bolesti digestivnog sistema Kliničkog centra Srbije, Beograd)
Novaković I. (Institut za humanu genetiku MF, Beograd)
Ignjatović I. (Institut za bolesti digestivnog sistema Kliničkog centra Srbije, Beograd)
Dimitrijević Ivan (Institut za psihijatriju KCS, Beograd)
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