Post hysterectomy scar endometriosis: An unusual entity

Scar endometriosis is rare and poses a diagnostic difficulty. Though often asymptomatic, it may present as vague pain in the abdomen during menstruation. Differential diagnoses include abscess, hematoma, sarcoma, desmoid tumour, suture granuloma or metastatic malignancy. Diagnosis is frequently made only after excision and histopathology report. We report a case of a 28 year old multiparous female with a surgical history of uncomplicated cesarean sections followed by total abdominal hysterectomy presented with lower abdominal pain. On examination, a well healed Pfannenstiel incisional scar with a 4x4cm lump in the midline was noted. A diagnosis of scar endometriosis was made. The patient underwent laparotomy. Left sided salpingo oophorectomy with excision of endometriotic cyst. Histopathology confirmed the diagnosis of endometriosis.Conclusion: Scar endometriosis is a rare entity occurring post abdominal surgeries. It poses a diagnostic challenge and confirmation is made only after histopathology. Hence a high degree of suspicion is required to make a diagnosis and guide further treatment.