An episiotomy scar site endometriosis: a rare case report and review of literature

Kalaivani Thirupathi, Nithya Rengaraj
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2022 · vol. 11(8) , pp. 2292 · doi:10.18203/2320-1770.ijrcog20221958 · W4288051277
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This case report details a rare instance of endometriosis occurring at an episiotomy scar site in a young woman, presenting with a painful, menstrually-associated mass diagnosed via MRI and treated with surgical excision.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This paper reports a rare case of endometriosis arising at an episiotomy scar site in a 29-year-old woman who developed a painful, menstruation-associated swelling near the prior perineal incision, and it reviews related literature on surgical scar endometriosis. Diagnosis was supported by pelvic MRI and confirmed after wide local excision with histopathological examination to exclude malignant transformation; the report notes MRI as the most commonly used imaging approach to assess extent. The authors also discuss that perineal scar endometriosis is very uncommon and mainly affects young females following vaginal delivery. This paper is centrally about endometriosis — specifically surgical scar site (episiotomy/perineal) endometriosis.

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Abstract

Endometriosis can be defined as the presence and growth of functioning endometrial tissue (glands and or stroma) outside the endometrium. Occasionally, surgical scars are the sites of endometriotic implantation particularly perineal scars (episiotomy). Perineal scar endometriosis is a very rare condition, its incidence rate was about 0.03-0.15%. Perineal scar endometriosis mainly affects young females at the episiotomy site following a previous vaginal delivery. A 29 years old patient presented with swelling at the site of episiotomy which was associated with pain during menstruation. On examination a palpable mass was revealed without induration at close proximity to episiotomy scar site during menstruation. MRI pelvis is the most commonly used imaging technique for the diagnosis of perineal endometriosis as well as to assess the deeper extent of the lesion. Mass excised and sent for histopathological examination. Wide local excision is the definitive treatment for surgical site endometriosis. Follow up is recommended for recurrence. The rare possibility of malignant transformation, can be excluded by histopathological examination of excised tissue.
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An episiotomy scar site endometriosis: a rare case report and review of literature DOI: https://doi.org/10.18203/2320-1770.ijrcog20221958Keywords: Endometriosis, Surgical scar site endometriosis, Perineal scar endometriosis, Episiotomy scar endometriosisAbstract Endometriosis can be defined as the presence and growth of functioning endometrial tissue (glands and or stroma) outside the endometrium. Occasionally, surgical scars are the sites of endometriotic implantation particularly perineal scars (episiotomy). Perineal scar endometriosis is a very rare condition, its incidence rate was about 0.03-0.15%. Perineal scar endometriosis mainly affects young females at the episiotomy site following a previous vaginal delivery. A 29 years old patient presented with swelling at the site of episiotomy which was associated with pain during menstruation. On examination a palpable mass was revealed without induration at close proximity to episiotomy scar site during menstruation. MRI pelvis is the most commonly used imaging technique for the diagnosis of perineal endometriosis as well as to assess the deeper extent of the lesion. Mass excised and sent for histopathological examination. Wide local excision is the definitive treatment for surgical site endometriosis. Follow up is recommended for recurrence. The rare possibility of malignant transformation, can be excluded by histopathological examination of excised tissue. Metrics References Sharma N, Khan DA, Jethani R, Baruah S, Dey B. Perineal Endometriosis in an Episiotomy scar: A Case Report and Review of Literature. Gynecol Obstet Case Rep. 2018;4(2):66 Saloum NM, Quershi S, Ibrahim SA, Alrashid A. A rare case report of endometriosis in an episiotomy scar without anal sphincter involvement. EC Gynaecol. 2018;7:466-70. de Gauna BR, Rodriguez D, Cabre S, Callejo J. A case of endometriosis in episiotomy scar with anal sphincter involvement. Int J Clin Med. 2011;2:624-6. Leite G, Carvalho LF, Korkes H. Scar endometrioma following obstetric surgical incisions: Retrospective study on 33 cases and review of the literature. Sao Paulo Med J. 2009;127:15-7. Jeyaseelan S, Kwatra N. A rare case of episiotomy scar endometriosis. J Obstet Gynecol India. 2016;66:654-5. Gauna BRD, Rodriguez D, Cabre S, Callejo J. A Case of Endometriosis in episiotomy scar with anal sphincter involvement. Int J Clin Med. 2011;2:624-6. Goel P, Sood SS, Dalal A, Romilla. Caesarean scar endometriosis: Report of two cases. Indian J Med Sci. 2005;59:495-8. Sharma N, Theik JL, Rituparna D, Mishra J, Singh AS. Incisional endometriosis: A rare case of painful scar. J Midwifery Reproductive Health. 2017;5:927-9. Al-Jabri K. Endometriosis at caesarean section scar. OMJ. 2009;24:294-5. Jain D. Perineal scar endometriosis: A comparison of two cases. BMJ Case Rep. 2013;29:1. Andola US, Andola SK, Sanghvi KJ. FNAC diagnosis of Scar endometriosis: A report of 3 cases with review of literature. J Basic Clin Reprod Sci. 2012;1:62-4. Kang SK, Lee MW, Choi JH, Sung KJ, Moon KC. Cutaneous endometriosis: A combination of medical and surgical treatment. J Dermatolog Treat. 2002;13:189-92. Cinardi N, Franco S, Centonaze D, Giannone G. Perineal scar endometriosis 10 years after Miles’ procedure for rectal cancer: Case report and review of literature. Int J Surg Case Reports. 2011;2:150-3. Medeiros FC, Calvalcante DM. Fine needle aspiration cytology of scar endometriosis: A study of seven cases and literature review. Diagnostic Cytopathology. 2011;39:189-92. Paull T, Tedischi LG. Perineal endometriosis at the site of episiotomy scar. Obstet Gynecol. 1972;40:28-34.

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