Cesarean-Section Scar Endometrioma: A Case Report and Review of the Literature

Abstract

Endometriomas can occur after any surgery where there is endometrial manipulation, and there are a number of reports of endometriomas developing in the abdominal wall at the site of the Pfannenstiel incision following Cesarean-section. Although this is ultimately a histopathologically-confirmed diagnosis, preoperative imaging including ultrasound, computed tomography, and magnetic resonance imaging may be helpful in the diagnosis and assessment. We report a pathology-confirmed case of Cesarean-section endometrioma with a classic, clinical presentation and imaging findings on computed tomography. A comprehensive literature review and discussion of the multi-modality imaging appearance of Cesarean-section endometrioma is also provided.

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

“…The differential diagnosis of ISE may include other causes of abdominal wall mass like desmoid tumor, hematoma, fibrosis, suture granuloma, keloid scar, nodular fasciitis, and incisional hernia 3,7 .…”

Hasfali endometriosis: differenciáldiagnosztikai nehézségek a radiológus szemszögéből

“…Császármetszés után kialakult endometriosis során a betegnek a szülés után hónapokkal vagy akár évekkel jelentkeznek panaszai. A császármetszés hegében lévő endometriosis kialakulása nincs összefüggésben azzal, hogy a beteg hány császármetszésen esett át élete folyamán [15]. A császármetszés hasfali hege körül kialakult endometriosis akut hasi kórképet is utánozhat [16].…”

“…Az endometrioma a kontrasztanyagot fokozottan halmozza, és mivel sejtdús, a vízmolekulák Brown-mozgása korlátozott, tehát körülírt, diffúziójában mérsékelten gátolt képletként jelenik meg. A vizsgálat során képet kaphatunk a hasüregben lévő, ultrahangvizsgálat során nehezen vagy nem azonosítható ectopiás endometriumszövetről is (4. ábra) [15].…”

Endometriosis of Postoperative Scar

“…Nevertheless scar endometriosis occurs also after general surgery-appendectomy, cholecystectomy, and correction of hernias [2]. The term "endometrioma" is used for well-marked tumor-like lesions [3]. However, there may be a situation characterized by a typical clinic of endometriosis in the absence of a clearly defined lesion, and this makes diagnosis difficult.…”

“…Its clinical diagnosis is confused with abscess, hematoma, suture granuloma, desmoid tumor, sarcoma, etc. Incidence rates for endometrioma associated with cesarean section have been reported to be 0.01-4% [3]. The incidence of endometrioma in episiotomy scars is much less than in abdominal wall scars.…”