Rare Case Series of Scar Endometriosis

Abstract

Background: Scar endometriosis is an uncommon form of endometriosis that occurs in surgical scars, primarily following obstetric and gynaecologic procedures. Due to its rarity and non-specific symptoms, scar endometriosis poses significant diagnostic challenges and often leads to delayed diagnosis and treatment.

Objective: To present a series of rare cases of scar endometriosis, highlighting clinical features, diagnostic approaches, treatment modalities, and outcomes.

Methods: This case series includes five patients diagnosed with scar endometriosis, each presenting with cyclical pain and swelling at the site of previous surgical scars. The diagnosis was confirmed through clinical examination, imaging studies, and, in some cases, biopsy. Treatment involved surgical excision of the endometriotic tissue.

Results:

1. Case 1: A 30-year-old woman with a history of caesarean section presented with cyclic pain and swelling at the caesarean scar. The diagnosis was confirmed via ultrasound and MRI. Surgical excision resulted in complete symptom resolution with no recurrence at 18 months follow-up.


2. Case 2: A 34-year-old woman with a history of hysterectomy experienced persistent pain at the hysterectomy scar site. Imaging confirmed scar endometriosis and surgical excision led to symptom-free status 15 months post-surgery.


3. Case 3: A 37-year-old woman with a prior episiotomy presented with swelling and pain at the episiotomy scar, which worsened during menstruation. Surgical excision provided successful symptom resolution, with no recurrence at 12 months follow-up.


4. Case 4: A 29-year-old woman with a history of laparoscopic surgery for ovarian cysts reported cyclical pain at the laparoscopic port site. MRI confirmed endometrial tissue and surgical excision resulted in complete symptom resolution with no recurrence at 14 months follow-up.


5. Case 5: A 40-year-old woman with multiple abdominal surgeries, including myomectomy, presented with cyclical pain and a palpable mass at a previous surgical site. Ultrasound confirmed scar endometriosis, and surgical excision led to no recurrence or symptoms during ten month's follow-up.

Conclusion: Scar endometriosis should be considered in women with cyclic pain and swelling at surgical scar sites, especially those with a history of obstetric or gynaecologic surgery. Early diagnosis and surgical management are crucial for effective treatment and symptom resolution. Regular follow-up is recommended to monitor for recurrence. This case series underscores the importance of recognizing and appropriately managing this rare condition.

This abstract highlights the case series' key aspects, emphasizing the condition's rarity, clinical presentation, diagnostic strategies, treatment outcomes, and the importance of long-term follow-up.