Caesarean Scar Endometriosis - A Rare Case Report

Abstract

Background *
Endometriosis is the presence of ectopic functioning endometrial tissue outside the uterine cavity. Scar endometriosis is a rare condition that typically follows obstetrical and gynaecological surgeries. The diagnosis of scar endometriosis remains challenging and requires a comprehensive approach, including clinical presentation and histological and radiological findings. We are reporting a case of 28 yr old parous woman with 2 prior LSCS admitted to our hospital presented with a chief complaint of pain at the scar site persisting for the past 4 months, with a gradual increase in intensity over the last 2 months. on clinical and radiological examination, it was found to be a left sided mass noted in the lower abdomen. on laparotomy 4*4 cm size scar endometriotic tissue. On HPE, suggestive of scar endometrioses with inter-spread endometrial glands.

Results *
Ultrasonography reported a hypoechoic lesion measuring 2.5x1.5cm with irregular borders noted in left iliac fossa region in subcutaneous region indenting rectus muscle with no internal vascularity. An MRI abdomen was taken and shows round nodular lesion with spiculated margins noted in left lower abdomen in deep subcutaneous flat planes abutting rectus abdominus. Minimal fat stranding noted adjacent to the lesion and it concluded that it is likely to represent a scar endometriosis, correlating with clinical history after which she underwent laparotomy for the same. 

Conclusion *
Scar endometriosis is a rare and elusive diagnosis often mimicking with a variety of clinical conditions, and presenting as a diagnostic dilemma. Physicians’ ought to maintain a high degree of suspicion in a reproductive age group women presenting with pain and localized symptoms at the site of incision following gynaecological/obstetric surgery.