The clinical characteristics and surgical approach of scar endometriosis: A case series of 14 women

Abstract

Scar endometriosis, also referred to as abdominal wall endometriosis (AWE), is a rare form of endometriosis that usually develops in the scar after obstetric or gynecological surgeries, including cesarean section (CS). Recently, the occurrence of scar endometriosis has been increasing together with the increase of CS incidence. Scar endometriosis can be clinically misdiagnosed as hernia, lipoma, or hematoma. Here we retrospectively analyzed the clinical aspects of scar endometriosis and surgical approach in 14 patients from a tertiary hospital, who were treated by surgery, between 2012 and 2017. The mean age was 32.71 ± 8.61 years (range: 19-45). Palpable mass and cyclic pain at the scar site were the most common complaints. Twelve patients had previously undergone CS, and two patients had undergone a surgery of ovarian endometrioma. The preoperative diagnosis was determined with ultrasonography (US), magnetic resonance imaging (MRI), or computed tomography (CT). Preoperatively, scar endometriosis was diagnosed in 12/14 patients (85.7%), while 2 patients (14.3%) were diagnosed with inguinal hernia. The treatment was surgical excision in all patients; in addition, mesh repair surgery was performed in 1 patient with recurrent scar endometriosis. Postoperatively, endometriosis was confirmed by histology in all patients. The average size of endometriomas was 24.71 ± 6.67 mm (range: 11-35). No woman had concurrent pelvic endometriosis. In the follow-up period (mean: 9 months) the recurrence of endometriosis was not observed. Scar endometriosis should be considered in all women of reproductive age presenting with cyclic pain and swelling in their abdominal incision sites.

Parietal Mass: Two Case Reports of Rare Cesarean Scar Endometriosis

“…Surgical treatment offers the best chance for making a definitive diagnosis and treating cesarean scar endometriosis. The excision should include clear margins of at least 1 cm away from the solid tissue [16]. In addition to this, the abdominal wall endometriosis incorporated into the musculature of the abdominal wall requires en bloc resection of the underlying myofascial elements and the excision site must be sterilized by neomycin solution or 0.9% sodium chloride solution [17][18].…”

Abdominal wall endometriosis: clinical presentation, imaging features and management of five cases

“…It seems that radiologists are in general not familiar with the spectrum of endometriosis imaging features. The most common differential diagnoses include dermoid tumors, hematomas, keloids, granulomas, metastases, and lymphoma [13,14]. Dermoid tumors may mimic the radiological appearance of endometriomas but lack the cyclic changes.…”

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

“…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 .…”

“…Intra-pelvic endometriosis is developed in different pelvic structures like ovaries, uterosacral ligaments, pelvic peritoneum, recto-uterine pouch, cervix, vagina, and round ligament. Although extrapelvic endometriosis is rare but may develop in gastrointestinal tract, respiratory tract, urinary tract, skin, brain, and abdominal wall 2 .…”