Painful scar endometriosis after caesarean section

Indu Gaur, Kanishka Kumar
International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2022 · vol. 11(4) , pp. 1300 · doi:10.18203/2320-1770.ijrcog20220923 · W4220795423
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This case report describes scar endometriosis occurring after a cesarean section, presenting as cyclical pain and swelling at the surgical site, and discusses its surgical management and histopathological confirmation.

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

This paper describes a single 31-year-old case of painful scar endometriosis occurring in a suprapubic Caesarean section scar area after two prior deliveries, with monthly cyclical swelling and pain for two years. Clinical examination and investigations supported the diagnosis, and the patient received medical treatment with oral contraceptives and GnRH analogues, but symptoms recurred after stopping therapy. Surgery found a dense fibrotic mass involving the rectus sheath, part of the rectus muscle, and subcutaneous tissue, and histopathology confirmed scar endometriosis with glands and stroma, with an uneventful postoperative course; the main limitation is that the evidence is a single-case report. This paper is centrally about endometriosis — painful abdominal wall scar endometriosis after caesarean section.

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Abstract

Scar endometriosis is an extremely rare phenomenon. We presented a case of scar endometriosis in a thirty one year old patient (P2L2) who developed swelling and cyclical pain in the previous suprapubic caesarean scar (of previous two caesarean sections) area lasting for 10 days every month for last 2 years. On abdominal examination she had a small swelling at right margin of the wound which was firm and tender on examination with dull aching constant pain at the site of examination. This pain used to aggravate with menses. Investigations suggested scar endometriosis and she was treated medically with oral contraceptives and GnRH but symptoms recurred on stopping the treatment. Patient underwent surgery. A dense fibrotic tissue of 5×4×5 cm size including the rectus sheath, part of rectus muscles and subcutaneous tissue was found on the right side of the old previous scar beneath the skin which was excised and sent for histopathological examination which reconfirmed the diagnosis of scar endometriosis with presence of glands and stroma in the excised tissue. Post-operative period was uneventful.
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Painful scar endometriosis after caesarean section DOI: https://doi.org/10.18203/2320-1770.ijrcog20220923Keywords: Scar endometriosis, Painful, Caesarean section, Oral contraceptives, GnRH analoguesAbstract Scar endometriosis is an extremely rare phenomenon. We presented a case of scar endometriosis in a thirty one year old patient (P2L2) who developed swelling and cyclical pain in the previous suprapubic caesarean scar (of previous two caesarean sections) area lasting for 10 days every month for last 2 years. On abdominal examination she had a small swelling at right margin of the wound which was firm and tender on examination with dull aching constant pain at the site of examination. This pain used to aggravate with menses. Investigations suggested scar endometriosis and she was treated medically with oral contraceptives and GnRH but symptoms recurred on stopping the treatment. Patient underwent surgery. A dense fibrotic tissue of 5×4×5 cm size including the rectus sheath, part of rectus muscles and subcutaneous tissue was found on the right side of the old previous scar beneath the skin which was excised and sent for histopathological examination which reconfirmed the diagnosis of scar endometriosis with presence of glands and stroma in the excised tissue. Post-operative period was uneventful. Metrics References Francica G, Giardiello C, Angelone G, Cristiano S, Finelli R, Tramontano G. Abdominal wall endometriosis near caesarean delivery scars. J Ultrasound Med. 2003:22(10):1041-7. Khoo JJ. Scar endometriosis presenting as an acute abdomen: a case report. Aust NZ Obstet Gynaecol. 2003;43(2):164-5. Kaloo P, Reid G, Wong F. Caesarean section scar endometriosis: two cases of recurrent disease and a literature review. Aust NZ J Obstet Gynaecol. 2002;42(1):218-20 Brenner C, Wohlgemuth S. Scar endometriosis. Surg Gynecol Obstet. 1990;170(6):538-40. Tanos B, Anteby SO. Caesarean scar endometriosis. Int J Gynaecol Obstet. 1994;47(2):163-6. Douglas C, Rotimi O. Extragenital endometriosis: a clinicopathological review of Glasgow hospital with case illustrations. J Obstet Gynaecol. 2004;24(7):804-8. Patterson GK, Winburn GB. Abdominal wall endometriomas: report of eight cases. Am Surg. 1999;65(1):36. Horton JD, Dezee KJ, Ahnfeldt EP, Wagner M. Abdominal wall endometriosis: a surgeon’s perspective and review of 445 cases. Am J Surg. 2008;196(2):207. Hensen JH, Vriesman AC, Puylaert JB. Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography. AJR Am J Roentgenol. 2006;186(3):616-20. Blanco RG, Parithivel VS, Shah AK, Gumbs MA, Schein M, Gerst PH. Abdominal wall endometriomas. Am J Surg. 2003;185(6):596-8.

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