A Case of Endometriosis in Episiotomy Scar with Anal Sphincter Involvement

Abstract

Endometriosis is defined as the presence of endometrial tissue apart from its usual location (endometrium). It is the second most prevalent benign gynecologic disease after the presence of fibroids in women of childbearing age (incidence of 10% - 25%). Endometriosis predominantly locates on peritoneal surfaces, but it also affects the vagina, vulva, recto-vaginal septum and perineum, usually secondary to surgical or obstetric trauma. We present a case of a patient with perineal endometriosis (single nodule) in the scar of episiotomy and involvement of external anal sphincter with local and catamenial pain but with continence maintained. The endometric nodule was removed, and wide dissection and sphincteroplasty were performed. Afterwards, treatment with GnRh analogues was prescribed for a four-month period. Surgical outcome was successful and the patient was asymptomatic during subsequent menstruations

An episiotomy scar site endometriosis: a rare case report and review of literature

“…Severe morbidity and prolonged illness were observed in patients due to damage of the adjacent structures like anal sphincter or rectum at later stages. 6 Proposed etiopathogenetic theories of endometriosis were direct implantation theory, colemic metaplastic theory, haematogenous spread, lymphatic dissemination, macrophagic theory and iatrogenic implantation theory.…”

“…Reported incidence rate of Perineal endometriosis is about 0.3-1%. 3 At the time of delivery, episiotomy is frequently performed. So, one should know about this rare entity and certain measures can be taken to prevent its occurrence.…”

Varied clinical presentations of scar endometriosis: case reports

“…It was first described by Rokitansky in 1860.In 1896, Allen described for the first time extra-genital endometriosis and since then various cases have been reported. 6 Endometriosis implants developing in the subcutaneous tissue of surgical scars occur most frequently after gynaecological and obstetrical procedures, including caesarean sections, hysterotomies, hysterectomies. Perineal scar endometriosis is a rare entity with incidence upto 1% affecting females at the episiotomy site following a previous vaginal delivery about 1-20 yrs back.…”

Episiotomy site endometriosis: a rare case report

“…Endometriosis is defined as the presence of functional endometrial tissue outside the uterine cavity. 1 Endometriosis occur in 5-10% of all women often resulting in severe dysmenorrhoea and infertility. Although most frequently found in pelvis extra-pelvic sites may range from lungs to extremities.…”

“…Incisional scar after gynaecological surgery and caesarean section is a relatively uncommon disease, accounting approximately 1% of all cases out of which perineal scar endometriosis incidence is reported to be 0.3% to 1%. [1][2][3] This entity often leads to mis-diagnosis and delayed treatment owing to its vague clinical presentation. The diagnosis is frequently made by surgical exploration and histo-pathological evaluation of excised tissue.…”