A Rare Cause of Abdominal Pain: Scar Endometriosis

Abstract

Introduction. Scar endometriosis (SE) is a rare pathology that develops in the scar tissue formed on the anterior abdominal wall usually after a cesarean section. There have been instances of women presenting to emergency or general surgery clinics with abdominal pain due to SE. Materials and Methods. This study retrospectively reviews 19 patients who were operated on in our clinic between January 2010 and January 2017 with a prediagnosis of SE and were reported to have SE based on their pathology results. Results. The mean age of the patients was 30.8 years (range: 20-49 years). The body mass indexes of 12 (63.2%) patients were ≥ 25. All patients had a history of cesarean section and 9 (47.4%) patients had undergone cesarean section once. With the exception of one patient who had her SE localized in her inguinal region, all patients had a mass localized on their anterior abdominal wall neighboring the incision and complained about cyclic pain starting in their premenstrual periods. The complaints began 2 years after their cesarean section in 10 (52.6%) patients. Mostly abdominal ultrasonography was used for diagnostic purposes. The lesions were totally excised and the SE diagnosis was made through a histopathological examination in all patients. No postoperative complications or recurrences were seen in any of the patients. Conclusion. Suspicion of SE is essential in women of reproductive age who have a history of cesarean section and complaints of an anterior abdominal wall mass and a pain at the scar site that is associated with their menstrual cycle. An accurate and early diagnosis can be established in such patients through a careful history and a good physical examination and possible morbidities can be prevented with an appropriate surgical intervention.

Cesarean Section: A Potential and Forgotten Risk for Abdominal Wall Endometriosis

“…Transabdominal ultrasonography is the preferred method for initial investigation due to reduced cost, fewer side effects, and easy accessibility [ 7 , 8 ]. Ultrasonography (USG) helps differentiate solid, cystic, and heterogeneous masses and describes its relation to the skin and fascia [ 12 , 16 ].…”

“…After the initial clinical assessment, diagnostic methods may be used in cases of uncertainty or to guide further management, such as abdominal ultrasonography (USG), computed tomography (CT), magnetic resonance imaging (MRI), and fine-needle aspiration (FNA) biopsy. Although, the definitive treatment and diagnosis is the surgical removal of the endometrial scar tissue with histopathological biopsy [ 5 , 8 ]. Malignant transformation of cesarean section (C-section) scar endometriosis is rare, presenting with high mortality and a survival rate of about 57% [ 7 ].…”

One of the rare reason of abdominal pain: abdominal wall endometriosis

“…Endometriosis was first described in 1860, and it affects 5%-10% of women population (1,2). It is most commonly located in the pelvis but in 12% of the published cases, it is also rarely observed in the gastrointestinal tract, lung, liver, bladder, kidneys, umbilicus, extremities, central nervous system and abdominal wall (1,3).…”

“…In the presence of the mass found, it can be mixed up with lipoma, abscess, hematoma, hernia, granuloma, desmoid tumor or sarcoma. The basic methods in diagnosing AWE are anamnesis and physical examination but ultrasound, computerized tomography, and sometimes magnetic resonance imaging of the abdomen are used in the differential diagnosis (3,4).…”

“…Although there are many theories in AWE etiology, the most accepted one is the direct spread of the endometrium cells through iatrogenic ways and the formation of endometriosis in the surgical field. Cesarean increases AWE formation 27 times in the society, and in recent years, AWE observation rate has increased in parallel with the increase in the cesarean section rate (1,3).…”