Rare case of scar endometriosis

Abstract

Endometriosis can sometimes occur in a previous surgical scar. The symptoms are nonspecific, typically involving abdominal wall pain at the incision site at the time of menstruation. A 31-year old woman with previous two caesarean section presents with cyclical abdominal pain and bleeding from the healed incision site. Examination revealed a well-healed caesarean scar, no mobile, firm, nodular, contender subcutaneous mass. Ultrasonography revealed a heterogeneous hypoechoic area with minimal internal vascularity. She was planned for scar excision after failed medical management. Intraoperatively, dense scar adhesions noted hence proceeded with total hysterectomy. Histopathological examination report confirmed the diagnosis of scar endometriosis. In conclusion, endometriosis is rare and difficult to diagnose. It should be suspected in woman of childbearing age with cyclic, painful nodule in a scar from a previous obstetric or gynecologic procedure, after excluding other differential diagnoses. Diagnosis is by imaging modalities and treatment of choice is usually surgical resection.