Scar endometriosis: a case report of this uncommon entity

Roshu Shetty, Winnie Bheda, Supriya Gaikwad
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2022 · vol. 11(7) , pp. 2038 · doi:10.18203/2320-1770.ijrcog20221693 · W4293058244
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This case report presents abdominal wall endometriosis occurring six years after caesarean delivery and discusses the epidemiology, pathogenesis, clinical features, diagnosis, treatment, and prevention of scar endometriosis.

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This case report examines scar endometriosis, a rare form of extra-pelvic endometriosis with an incidence rate between 0.03% and 0.1%. The authors present a specific instance of abdominal wall endometriosis in a woman who underwent a caesarean delivery six years prior to her presentation. The paper discusses the epidemiology, pathogenesis, clinical features, diagnosis, treatment, and prevention methods for this condition, noting that symptoms like menstrual pain at the incision site are often nonspecific. These vague presentations frequently lead to misdiagnosis as other conditions such as stitch granulomas or abscesses, which delays appropriate care. This paper is centrally about endometriosis — specifically focusing on the uncommon entity of scar endometriosis following surgical procedures like caesarean sections.

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Abstract

Scar endometriosis is an infrequent type of extra pelvic endometriosis that is associated with obstetrical and gynecological surgeries. Incidence of scar endometriosis is 0.03-0.1%. It is mostly confused with other dermatological or surgical conditions like stitch granuloma, dermoid, abscess and delays the diagnosis. The symptoms are nonspecific like pain over incision site during menstruation. Scar endometriosis is seen commonly following surgeries like caesarean deliveries, hysterectomies, hysterotomies, laparoscopic surgeries, episiotomy and amniocentesis tract. We present here a case of abdominal wall endometriosis in a woman who has undergone caesarean delivery six years prior to her current presentation. The epidemiology, pathogenesis, clinical features, diagnosis, treatment and methods of prevention of this somewhat rare condition are discussed
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Scar endometriosis: a case report of this uncommon entity DOI: https://doi.org/10.18203/2320-1770.ijrcog20221693Keywords: Scar endometriosis, Caesarean scar, Extra pelvic endometriosis, Abdominal wall endometriosisAbstract Scar endometriosis is an infrequent type of extra pelvic endometriosis that is associated with obstetrical and gynecological surgeries. Incidence of scar endometriosis is 0.03-0.1%. It is mostly confused with other dermatological or surgical conditions like stitch granuloma, dermoid, abscess and delays the diagnosis. The symptoms are nonspecific like pain over incision site during menstruation. Scar endometriosis is seen commonly following surgeries like caesarean deliveries, hysterectomies, hysterotomies, laparoscopic surgeries, episiotomy and amniocentesis tract. We present here a case of abdominal wall endometriosis in a woman who has undergone caesarean delivery six years prior to her current presentation. The epidemiology, pathogenesis, clinical features, diagnosis, treatment and methods of prevention of this somewhat rare condition are discussed Metrics References Nahir B, Eldar-Geva T, Alberton J, Beller U. Symptomatic diaphragmatic endometriosis ten years after total abdominal hysterectomy. Obstetrics and gynecology. 2004;104(5):1149-51. Jubanyik KJ, Committee F. Extrapelvic endometriosis. Obstetrics and Gynecology Clinics of North America. 1997;24(2):411-40. Steck WD, Helwig EB. Cutaneous endometriosis. Clinical Obstetrics and Gynecology. 1966;9(2):373-83. Minaglia S, Mishell DR, Ballard CA. Incisional endometriomas after cesarean section: a case series. Journal of Reproductive Medicine for the Obstetrician and Gynecologist. 2007;52(7):630-4. Dwivedi AJ, Agrawal SN, Silva YJ. Abdominal wall endometrioma. Digestive Diseases and Sciences. 2002;47(2):456-61. Kaunitz A, Di Sant’Agenese PA. Needle tract amniocentesis: an unusual complication of amniocentesis. Obstetrics and Gynecology. 1979;54(6):753-5. Koger KE, Shatney CH, Hodge K, McClenathan JH. Surgical scar endometrioma. Surgery Gynecology and Obstetrics. 1993;177(£):243-6. Wolf Y, Haddad R, Werbin N, Skornick Y, Kaplan O. Endometriosis in abdominal scars: a diagnostic pitfall. American Surgeon. 1996;62(12):1042-4. Aydin O. Scar endometriosis—a gynaecologic pathology often presented to the general surgeon rather than the gynaecologist: report of two cases. Langenbeck’s Archives of Surgery. 2007;392(1):105-9. Gunes M, Kayikcioglu F, Ozturkoglu E, Haberal A. Incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures. Journal of Obstetrics and Gynaecology Research. 2005;31(5):471-5. Scott RB, Telinde RW. Clinical external endometriosis; probable viability of menstrually shed fragments of endometrium. Obstetrics and gynecology. 1954;5(4):502-10. Roncoroni L, Costi R, Violi V, Nunziata R. Endometriosis on laparotomy scar: a three-case report. Archives of Gynecology and Obstetrics. 2001;265(3):165-7. Blanco RG, Parithivel VS, Shah AK, Gumbs MA, Schein M, Gerst PH. Abdominal wall endometriomas. The American Journal of Surgery. 2003;185(6):596-8. Sevdel AS, Sickel SJ, Warner ED, Sax HC. Extrapelvic endometriosis: diagnosis and treatment. The American Journal of Surgery. 1993;177(2):243-6. Kinkel K, Frei KA, Balleyguier C, Chapron C. Diagnosis of endometriosis with imaging: a review. European Radiology. 2006;16(2):285-98. Balleyguier C, Chapron C, Chopin N, H ́el ́enon O, Menu Y. Abdominal wall and surgical scar endometriosis: results of magnetic resonance imaging. Gynecologic and Obstetric Investigation. 2003;55(4):220-4. Crum CP. The female genital tract. In: Robbins Pathologic Basis of Disease. Cotran RS, Kumar V, Collins V (editors). Saunders, Philadelphia, Pa, USA. 6th edition. 1999. Meti S, Wiener JJ. Scar endometriosis—a diagnostic dilemma. European Clinics in Obstetrics and Gynaecology. 2006;2(2):62-4. Rivlin ME, Das SK, Patel RB, Meeks GR. Leuprolide acetate in the management of cesarean scar endometriosis. Obstetrics and Gynecology. 1995;85(5):838-9. Rani PR, Soundararaghavan S, Rajaram P. Endometriosis in abdominal scars—review of 27 cases. International Journal of Gynecology and Obstetrics. 1991;36(3):215-8.

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