Scar Endometriosis: A Case Report of a Rare Complication of Laparotomy for Ectopic Pregnancy

The presence of endometrium outside the uterine cavity is known as endometriosis. Scar endometriosis is an endometriosis present in or connected to a previous scar and is a relatively rare entity. Generally, a history of prior laparotomy, mostly cesarean section, is elicited. Case Report: A 28-year-old female, Para-2 Live-2 with exploratory laparotomy for ectopic pregnancy; presented to our hospital with a complaint of pain in the abdomen during menses for the past 1 year. She also complained of swelling in the lower abdomen since 10 months. She had two normal vaginal deliveries and history of exploratory laparotomy 3 years back for ruptured ectopic pregnancy of 2 months. A curved incision was placed around the nodule The nodule of around 3 cm 2 cm was excised from the subcutaneous tissue extending up to the right rectus muscle and the defect was repaired with Vicryl 2-0 RB and closure of fat plane and skin was performed. Discussion: Scar endometriosis is an infrequent type of extrapelvic endometriosis. The incidence of scar endometriosis is 0.03-0.15% of all cases of endometriosis. The generally accepted hypothesis for scar endometriosis is "Iatrogenic/accidental implantation of endometrium in the wound during a laparotomy/laparoscopy". Ultrasonogram (USG) scan and computerized tomography (CT) scan would ascertain the diagnosis in most cases and also act as guiding tools for fine-needle aspiration of such masses; especially to exclude malignancy. Management generally involves a wide local excision of the lesion. Sometimes, surgical excision may be combined with postoperative adjuvant therapy like gonadotropinreleasing hormone (GnRH) analog or dienogest. Primary prevention is always better than treating it later.