A case of scar endometriosis in cesarean scar
Diptee Poudel, Kshitiz Acharya, Sampada Dahal, Ashmita Adhikari
Abstract
INTRODUCTION: Scar endometriosis is a rare entity characterized by presence of functional endometrial tissue in the site of surgical scar. Cesarean section scar is the most common reported site. We herein report a case of cesarean scar endometriosis in a 43-years-old female patient. CASE PRESENTATION: A 43 year old female, with history of lower segment cesarean section 8 years back, presented to our center with complains of pain and palpable lump during menstruation, at the site of cesarean scar. On ultrasonography she was said to have some pathology in her previous surgical scar site. On MRI, a soft tissue mass measuring 25 × 35 mm within the subcutaneous tissue of anterior abdominal wall on the left side was seen. She was planned for surgical removal of the tissue. DISCUSSION: Scar endometriosis is a rare entity. The iatrogenic implantation of the hormone sensitive endometrial tissue into the edge of the wound during surgery best explains its occurrence. They usually present as a painful nodule in the site of surgical scar that undergoes cyclic variation with the menstrual cycle. Diagnosis can be confirmed by radiography. Treatment options can be medical and surgical, the latter being more effective and the preferred one. CONCLUSION: Scar endometriosis often mimics with variety of clinical conditions, so high degree of suspicion is necessary. Efforts should be aimed at minimizing the transfer of endometrial tissue into the subcutaneous area. Gloves replacement prior to closure can avoid the implantation of endometrial tissue into the abdominal wall.