Cesarean Scar Endometriosis: An Uncommon Surgical Complication on the Rise? Case Report and Literature Review

Abstract

Endometriosis is defined by the presence and growth of ectopic functional endometrial tissue outside the uterus. Scar endometriosis has been described following obstetrical and gynecological surgery. It is a rare condition, though probably on the rise, due to the considerable increase of cesarean sections performed worldwide. Its physiopathology is complex; its symptomatology is rich and diverse but thorough clinical examination along with ultrasound imaging and potentially pretherapeutic cytologic evaluation are usually efficient in diagnosing the condition. Treatment is mostly surgical. We report the case of a cesarean section scar endometriosis, managed at a tertiary level center and emphasize the diagnosis and treatment options.

The clinical characteristics and surgical approach of scar endometriosis: A case series of 14 women

“…Although the risk factors for scar endometriosis are not well known, it has been shown that previous uterine surgery, especially CS, is the most common risk factor for this condition [10,11]. As a possible cause of AWE after CS, the iatrogenic implantation of endometrial tissue into the abdominal fascia and subcutaneous tissue during the procedure has been suggested [12]. However, this theory does not explain the development of endometriosis in distant organs.…”

The scar constituent Collagen I triggers coordinated collective migration and invasion in a 3D spheroid model of early endometriotic lesions

“…In particular, the invasive modes cells adopted using the 3-D spheroid model but not single cells on ECM could, for the first time, reproduce collective-migration phenotypes previously identified only through histological and clinical observations, further confirming the relevance of this model. Several clinical studies suggested endometriosis can only implant in damaged tissues 33,34,35 . To investigate this in vitro, we mimicked the intact tissue using the basement membrane mimic Matrigel and scar-tissue mimic collagen I.…”

An increasing trend of iatrogenic scar endometriosis after lower segment cesarean section

“…In some studies authors suggested that FNAC can be the option for the definitive diagnosis of scar endometriosis prior to surgical intervention. On the contrary, in other studies the authors didn't encourage to use this technique as a diagnostic tool because with this procedure there is an increased risk of de-novo endometriotic implants at the puncture site, as well as organ injury if the diagnosis is uncertain 6,8,11 . Wide local surgical excision with 1 cm negative margin is the most recommended treatment modality for the scar endometriosis.…”