Post-cesarean scar endometriosis

Abstract

Objective:Endometriosis is seen in women during their reproductive period, where stromal tissue and functional endometrial glands of the uterus are observed outside the uterine cavity. In this study, we aimed to identify the clinical characteristics of our patients who underwent surgery with scar endometriosis and to discuss the surgical results in light of the literature.Materials and Methods:A total of 24 patients who underwent surgery and diagnosed as having endometriosis as the result of a pathologic examination were retrospectively evaluated.Results:The mean age of the patients was 31 years. Thirteen presented to general surgery and 11 presented to gynecology outpatient clinics. The pain was cyclical in 19 patients. There was history of cesarean section in 9 patients, twice in 12, and 3 times in three patients. The mean diameter was 39.1 mm on ultrasound, and 37.5 mm on magnetic resonance imaging. Endometriosis was on the left side of the incisions in 13, whereas it was on the right in 11. The mean weight of the lesions was 61.6 grams.Conclusion:The occurrence of endometriosis is supported by the iatrogenic implantation theory. In the event of a mass in the abdominal wall, previous obstetric and gynecologic operations and a history of a painful mass during menstruation periods must be questioned. In the treatment of scar endometriosis, excision is required by obtaining secure margins. If diagnosis can be established preoperatively, unnecessary surgeries can prevented.

An increasing trend of iatrogenic scar endometriosis after lower segment cesarean section

“…Prevention of decidual cell contamination to the superficial abdominal layers may reduce the occurrence of ISE 16 . Early diagnosis of ISE and timely surgical intervention and excision of endometrioma is crucial because failure to perform the necessary treatment, or any delay in performing the treatment may have a detrimental effect on the quality of life of the patient 8 .…”

“…In some studies authors suggested that FNAC can be the option for the definitive diagnosis of scar endometriosis prior to surgical intervention. On the contrary, in other studies the authors didn't encourage to use this technique as a diagnostic tool because with this procedure there is an increased risk of de-novo endometriotic implants at the puncture site, as well as organ injury if the diagnosis is uncertain 6,8,11 . Wide local surgical excision with 1 cm negative margin is the most recommended treatment modality for the scar endometriosis.…”

“…The patients with cesarean scar endometriosis typically presented with a painful mass or lump on the abdominal wall or at the cesarean scar site. The mass is becoming more tender and sometime may associate with bleeding during menstruation 8 . Our patient also reported to us with the typical presentation.…”

“…USG and MRI are the most accepted methods for the diagnosis of ISE. The typical USG features of SE includes a hypoechoic echogenic texture with internal scattered hyperechoic echoes 8,11 .…”

“…Wide local surgical excision with 1 cm negative margin is the most recommended treatment modality for the scar endometriosis. To repair the large defect after the excision polypropylene mesh should be used to reinforce the defect for the prevention of incisional hernia 2,8 .…”