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Case Reports
. 2022 Oct 19:36:e00457.
doi: 10.1016/j.crwh.2022.e00457. eCollection 2022 Oct.

Recurrent perineal scar endometriosis: A case report

Vimee Bindra  1 , Nikitha Reddy  2 , C Archana Reddy  1 , P Swetha  1 , Kishore V Alapati  2 , Madhavi Nori  3
Affiliations
Case Reports

Recurrent perineal scar endometriosis: A case report

Vimee Bindra et al. Case Rep Womens Health. .

Abstract

Introduction: Endometriosis is a chronic disease with the presence of endometrium-like tissue containing endometrial glands and stroma outside the uterus. The incidence of episiotomy scar endometriosis after vaginal delivery is 0.06-0.7%.

Case presentation: A 28-year-old parous woman with two previous vaginal deliveries with episiotomy presented to the outpatient department with severe pain and swelling in the perineal region over the past year, leading to difficulty in sitting, coitus and routine essential activities like defecation. She had undergone local perineal nodule excision surgery twice, which confirmed her perineal scar endometriosis diagnosis one year earlier at another hospital with no improvement in symptoms. Physical examination revealed a firm, tender, deeply embedded palpable nodule measuring approximately 3 - 4 cm in the left posterolateral aspect of the distal vagina. Wide local excision of the nodule with a clear margin of 1 cm was performed. The nodule extended up to the left ischial tuberosity and apex up to the pudendal vessels complex.

Discussion: The classic diagnostic triad of perineal endometriosis were present in this patient. Surgical intervention with wide local excision with a clear margin of approximately 1 cm of healthy tissue reduces the chance of recurrence.

Conclusion: Awareness of this condition among medical practitioners will lead to early diagnosis and excision. Timely intervention in the form of excision with free margins is the definitive treatment and provides complete pain relief and good quality of life for endometriosis patients.

Keywords: Chronic perineal pain; Episiotomy; Perineal endometriosis; Scar endometriosis; Wide excision.

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Conflict of interest statement

The authors declare that they have no conflict of interest regarding the publication of this case report.

Figures

Fig. 1
Fig. 1
: (A-F) Irregular spiculated mass in left ischial fossa abutting ischial tuberosity with deformity of left side of vagina secondary to scarring. Mass shows T2 hypointense signal with T2 hyperintense cystic foci on T2W images(A) and isointense signal on T1W (B). Hyperintense foci in T1FATSAT (C) consistent with blood signal. Irregular blooming on SW1 image (D) with restricted DW1 and low ADC value of 0.7 (E,F). These findings were consistent with scar endometriosis diagnosis extending up to the ischial tuberosity.
Fig. 2
Fig. 2
(A) Preoperative image showing puckered scar with deformed distal lumen of vagina. (B) Wide local excision abutting rectal wall. (C) Post-excision picture demonstrating the intact sphincter ani complex and dead space 5x6cm, which was allowed to heal by secondary intention.
Fig. 3
Fig. 3
(A) Excised specimen. B & C) Cut section showing full-thickness nodule.
Fig. 4
Fig. 4
(A) Endometrial glands showing columnar lining, 10×. (B) Irregular endometrial gland with surrounding compact stroma, 10×.
See this image and copyright information in PMC

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