Case series of scar endometriosis- post caeserean section: A diagnostic pitfall

The presence and growth of ectopic functional endometrial tissue outside the uterus is called endometriosis among which scar endometriosis is rare and difficult to diagnose. It occurs as a result of obstetrical and gynecological surgeries and can be confused with other surgical conditions. We reviewed the case records of patients with the diagnosis of scar endometriosis seen in our hospital from 2015 to 2018. We found six patients of scar endometriosis. The median age of the patients was 28.5 years (range 20-31 years) and median interval from symptoms to treatment was 4 years (range 2-6 years). Four patients had first presented to either the surgery or dermatology physicians. The most common complain being cyclical pain and swelling at local site. Patients underwent wide excision of the mass with no recurrence of symptoms at a follow up ranging from 9 months to 12 years. Confirmation of the diagnosis is histopathology with wide surgical excision being the treatment of choice. We have discussed the pathogenesis, diagnosis and treatment of this condition. Imaging techniques and FNAC are indicated towards better diagnostic approach and avoid confusion with other conditions. Medical treatment is helpful in selected cases only. After studying and presenting this paper we would like to highlight on such a rare condition and prevent its misdiagnosis.

Caesarean scar endometriosis

Endometriosis is defined by the presence and growth of ectopic functional endometrial tissue outside the uterus. The symptoms are nonspecific, typically involving abdominal wall pain at the time of menstruation. It commonly follows obstetrical and gynecological surgeries. The diagnosis is frequently made only after excision of scar the diseased tissue. A case report of 34 year old female patient presenting with scar endometriosis 7 years after her last LSCS (lower segment caesarean section). The patient came with the complaint of supra pubic swelling since 6 months, which was growing slowly. Her menstrual history was regular, but she had lower abdominal pain during menstruation. On clinical history, examination and USG finding the swelling was diagnosed as scar endometriosis.

Complications of Caesarean delivery part 2: Non-pregnant and pregnancy-related complications

Introduction With the rise in Caesarean deliveries, complications related to the procedure are increasingly encountered. Sonography has an indispensable role in the assessment of these complications and is often the first-line investigation of choice. Topic description: Part 2 of this pictorial review summarises the non-pregnant and pregnancy-related complications of Caesarean deliveries. Discussion Non-pregnant complications include Caesarean scar defects, scar endometriosis and malpositioned intrauterine devices. Complications related to future gestations include scar ectopic pregnancy, abnormal placentation and intrapartum uterine dehiscence or rupture. Key sonographic features of these conditions are illustrated. Pitfalls, mimics, limitations and indications for cross-sectional imaging are discussed. Conclusion Sound knowledge of the sonographic features of common non-pregnant and pregnancy-related complications of Caesarean delivery will facilitate accurate diagnosis, timely management and improved patient outcomes.

Case report on an enigma of caesarean section: ‘scar endometriosis’

Endometriosis is described as a disease in which functional endometrial glands and stroma that commonly lines the uterus grows outdoor the uterus. The resulting cystic or solid tumoral masses due to endometriosis are named as endometrioma. They're normally seen within the ligaments of uterus, ovaries, pouch of Douglas and pelvic peritoneum however endometriosis has additionally been noted in nose, breast, lung, spleen, gastrointestinal tract, kidney, abdominal wall, however scar endometriomas are extremely uncommon and difficult to diagnose. This situation may be puzzled with different surgical conditions, however imaging strategies and FNAC can assist in diagnosing it better. Medical treatment is helpful in selected cases but wide excision is the treatment of choice.

Bleeding abdominal scar endometriosis-a case report

Presence of functional endometrial tissue anywhere outside the uterine mucosa is called endometriosis. It is hormone dependent and almost exclusively it affects the women of reproductive age. Abdominal scar endometriosis is a rare condition and it is due to deposition of endometriotic tissue in the wound site during various obstetric or gynecological operative procedures. Scar endometriosis followed by lower segment caesarean section (LSCS) is very rare and presents with co-menstrual pain and bleeding. Our case presented with active bleeding from abdominal LSCS scar during menstruation which is extremely a rare presentation. Wide excision and histo-pathological examination confirm the diagnosis. A 28-year-old lady with previous history of LSCS 2 years back presented with complaining of swelling and bleeding from the previous LSCS scar during menstruation, persisting for 4-5 days, repeatedly in every menstrual cycle for last 6 months. On examination a swelling with active bleeding from it was noted over the previous LSCS scar. Routine investigation and coagulation profile was with in normal limit and on ultrasonography a firm mass was noted. After wide excision and histo-pathological Examination, the diagnosis was confirmed. Co-menstrual swelling, pain and bleeding from the previous LSCS scar should not be neglected and may be due to scar endometriosis.