UTERINE SCAR ENDOMETRIOMA: A CASE REPORT

Introduction And Importance: Uterine scar endometriosis is a rare form of endometriosis due to previous surgical scars from obstetrical and gynecological procedures. Its challenging diagnosis to make. A 34- Case presentation: year-old multiparous female presented with intermittent lower abdominal pain and inter-menstrual bleeding for the past 4 months .Ultrasound revealed a heterogenous, predominantly hyperechoic lesion measuring 40x51x54mm in the myometrium of anterior lower uterine segment extending to cervical stroma. MRI revealed a lobulated mass lesion in the anterior wall of lower uterine segment, extending along the scar niche. The lesion showed heterogenous hyperintense signal on T2WI with hyperintense signal on T1WI (sub-acute blood). No significant post contrast enhancement was seen. Impression of a scar site endometriosis was made. Subsequently the patient underwent diagnostic laparoscopy, which revealed a lobulated cystic mass in the lower uterine segment, with oozing of chocolate brown material on compression. As the mass was deep-seated in the lower uterine segment, a laparotomy was decided upon and total abdominal hysterectomy with varian conservation was performed. Histopathology confirmed the diagnosis of endometriosis. Conclusion: In any women of reproductive age with lower abdominal pain and solid appearing mass lesion at the uterine scar from previous obstetric or gynaecologic surgery, uterine scar endometriosis should be considered.