Scar Endometriosis: A Rare Cause of Abdominal Pain

Abstract

Scar endometriosis or incisional endometriosis is the presence of endometrial tissues with glands in the previous incision or scar. Its overall estimated incidence after post-cesarean and post-hysterectomy is 0.03-0.4% and 1.08-2%, respectively. The patient presents with non-specific symptoms such as cyclical abdominal pain at the site of a previous surgical incision and scar and an abdominal lump with a cyclical increment in size, which is tender. The diagnosis is made only after the surgical excision with confirmation by histopathological analysis. We present the case of a 31-year-old female complaining of cyclical abdominal pain and a lump on the right side of a Pfannenstiel incision for five months. She had undergone two Lower Segment Caesarean Sections (LSCSs); the last surgery was eight months prior. Surgical excision was planned with the corresponding clinical features and radiological data. After the surgical excision, the sample was sent for histopathological examination, and scar endometriosis was diagnosed.

Keywords: Pfannenstiel incision; lower segment cesarean section; scar endometriosis.

Figure 1

A lump of 5 × 3 cm encased in the fibrosis tissue, extending from the subcuticular plane, infiltrating the rectus sheath, and extending up to the anterior surface of the uterus.

Figure 2

Wide local excision 6 × 4 × 1.4 cm; grayish-brown to black in color.

Figure 3

The cut surface was grayish-white to solid brown homogeneous area with focal blackish discoloration.

Figure 4

(H&E stain × 40): Scattered numerous endometrial glands along with stroma; a few various calibered, congested, as well as dilated vascular channels; and mixed inflammatory cells predominantly comprising mature lymphocytes, histocytes, and plasma cells embedded against a background of fibro collagenous, muscular, and adipose stroma.

Figure 5

(H&E stain × 60): High-power view showing the scattered endometrial glands and stroma.

Figure 6

Endometrial gland with stroma.