BACKGROUND This report details the case of a 35-year-old woman who presented with cyclical abdominal pain diagnosed as cesarean scar endometriosis. Scar endometriosis is a phenomenon that occurs after abdominal/pelvic procedures like cesarean sections; after which, it is called cesarean scar endometriosis. It is frequently misdiagnosed as hernias, granulomas, abscesses, hematomas and neoplasms, and thus needs proper investigation to diagnose. The classic triad of symptoms are a positive surgical history, cyclical pain, and a mass at the surgical scar. Magnetic resonance imaging (MRI) is the imaging of choice owing to its high sensitivity and specificity when diagnosing scar endometriosis. CASE REPORT We report a 35-year-old woman who presented to the Obstetrics and Gynecology (OB/GYN) clinic with a triad of positive surgical history (cesarean section), cyclical abdominal pain, and an abdominal mass. Physical examination revealed a protruding, hyperpigmented mass at the left corner of the Pfannenstiel incision. An MRI was done, which showed a 3×3×3.5 cm left lower abdominal wall soft-tissue mass. A clinical diagnosis of scar endometriosis was made based on suggestive history, physical examination, and imaging. The mass was surgically removed and the patient made a full recovery. CONCLUSIONS Cesarean scar endometriosis is a complication of cesarean sections and should be a differential diagnosis when considering female patients with an abdominal mass and cyclical pain following an abdominal surgical procedure. A clinical diagnosis is made on the basis of thorough history-taking, physical examination, and imaging (particularly MRI). The criterion standard treatment is surgical excision. 

https://amjcaserep.com/download/inPress/idArt/940200

A Classical Case of Cesarean Scar Endometriosis in a 35-Year-Old Woman Presenting with Cyclical Abdominal Pain: A Case Report

Introduction Currently, there are few reports describing the use of reconstructive techniques in the treatment of cesarean scar endometriosis (CSE). Here, we report a case of CSE, a rare form of endometriosis caused by scars from obstetric and gynecological surgeries. Case Report. A 50-year-old woman became aware of a painful, deep scar mass in her lower abdomen during her menstrual period 10 years after her second cesarean section. This was diagnosed as CSE after the biopsy. Under general anesthesia, the mass, a portion of the rectus abdominis, and a 1 cm tumor-free margin were resected as a whole, and the abdominal wall was reconstructed with a soft artificial mesh. Results No obvious recurrence or subjective symptoms were observed postoperatively or reported in the 1-year follow-up period. Discussion. Endometriosis appearing in a cesarean scar is rare; it is chiefly triggered by intraoperative mechanical implantation. In cases of surgical scar masses with a history of gynecological surgery and associated menstrual symptoms, this syndrome should be considered during diagnosis and treatment.

Resection and Abdominal Wall Reconstruction for Cesarean Scar Endometriosis

Patient: Female, 35-year-old Final Diagnosis: Cesarean scar endometriosis Symptoms: Bleeding over lump in cesarean section scar • cyclical abdominal pain • hyperpigmentation of skin • mass in cesarean scar Clinical Procedure: Surgical excision of lump Specialty: Obstetrics and Gynecology Objective: Rare disease Background: This report details the case of a 35-year-old woman who presented with cyclical abdominal pain diagnosed as cesarean scar endometriosis. Scar endometriosis is a phenomenon that occurs after abdominal/pelvic procedures like cesarean sections; after which, it is called cesarean scar endometriosis. It is frequently misdiagnosed as hernias, granulomas, abscesses, hematomas and neoplasms, and thus needs proper investigation to diagnose. The classic triad of symptoms are a positive surgical history, cyclical pain, and a mass at the surgical scar. Magnetic resonance imaging (MRI) is the imaging of choice owing to its high sensitivity and specificity when diagnosing scar endometriosis. Case Report: We report a 35-year-old woman who presented to the Obstetrics and Gynecology (OB/GYN) clinic with a triad of positive surgical history (cesarean section), cyclical abdominal pain, and an abdominal mass. Physical examination revealed a protruding, hyperpigmented mass at the left corner of the Pfannenstiel incision. An MRI was done, which showed a 3×3×3.5 cm left lower abdominal wall soft-tissue mass. A clinical diagnosis of scar endometriosis was made based on suggestive history, physical examination, and imaging. The mass was surgically removed and the patient made a full recovery. Conclusions: Cesarean scar endometriosis is a complication of cesarean sections and should be a differential diagnosis when considering female patients with an abdominal mass and cyclical pain following an abdominal surgical procedure. A clinical diagnosis is made on the basis of thorough history-taking, physical examination, and imaging (particularly MRI). The criterion standard treatment is surgical excision.

Abstract Abdominal wall endometriosis is atypical localization of the extra-pelvic endometriosis with non-specific symptoms and is difficult for diagnosis. Cesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis, which usually develops after obstetric operations. We report a case of a 33-year-old woman who had two previous cesarean sections presented with a mass in the subcutaneous tissue of the abdominal wall, approximately 4 cm superior to the Pfannenstiel incision, 5 years after her second lower segment caesarean section. The classic clinical presentation, imaging findings on ultrasonography and computed tomography are analyzed. Treatment with local surgical excision of the mass is discussed. The diagnosis was confirmed with histopathological analysis of the surgical sample. When it comes to the limited painful lesion in the subcutaneous tissue at the cesarean scar, with a pain intensifying during menstruation, the physician should consider cesarean scar endometriosis in women of reproductive age with a history of cesarean section.

Abdominal Wall Endometriosis at the Cesarean Section Scar

One of the long-term complications of abdominal surgery is endometriosis of the postoperative scar (EPS). The frequency of this condition is 0.03–1.08%. Mechanical implantation of endometrium during primary surgery plays a leading role in the pathogenesis of EPS. Together with clinical manifestations, ultrasound and magnetic resonance imaging are important diagnostic tools for this postoperative complication. Differential diagnosis requires excluding suture granulomas, hematomas, fibroids, hernias, lipomas, seromas, abscesses, and other malignant and benign soft tissue tumors in the area of the scar. This article describes a case of EPS in two women who had undergone cesarean section. Adequate removal of endometrial infiltrates, followed by abdominoplasty, allowed them to avoid recurrence and achieve optimal cosmetic results. Currently, in order to prevent the occurrence of EPS after surgical delivery, it is recommended to change gloves after removing the afterbirth and before restoring the integrity of the anterior abdominal wall, as well as limiting the edges of the wound to the abdominal cavity. 

Endometriosis of a postoperative scar

Endometriosis is defined as an ectopic presence of endometrium-like tissue outside uterine cavity, which most commonly involves intraperitoneal organs. However, one of the less frequent forms of the disease is abdominal wall endometriosis usually developing in surgical scars following obstetric and gynaecological surgeries involving uterine cavity entering, that is, caesarean section, myomectomy or hysterectomy. In this case report we present a case of a patient with extensive caesarean scar endometriosis, who required complex surgical management. Successful surgical treatment involved not only radical tumour resection and application of mesh in postoperative hernia prevention but also adequate wound closure ensuring satisfactory cosmetic results, which was most challenging. The abdominal wall defect could not be sutured by traditional technique, thus polypropylene mesh was used and partial abdominoplasty was performed. The wound healed without complication and 24-month follow-up showed no evidence of local recurrence and satisfactory cosmetic result. In case of extensive endometrial abdominal wall tumours surgical treatment may involve application of advanced plastic surgery techniques, like abdominoplasty or skin/musculocutaneous flaps transposition.

Caesarean Scar Endometriosis May Require Abdominoplasty.

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Caesarean Scar Endometriosis May Require Abdominoplasty.